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hit— <br /> ! FOR41 APPRC&'ED <br /> OMB No. ISS— ^700 <br /> FOR AGENCY usE <br /> NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM <br /> APPLICATION FOR PERMIT TO DISCHARGE WASTEWATER <br /> STANDARD FORM A—MUNICIPAL <br /> SECTION L APPLICANT AND FACILITY DESCRIPTION <br /> unless otherwise Specified on this form ale Items aro to be cOmOlegd. It an item Is not appocaois indicate-MA.- <br /> ADDITIONAL INSTRUCTIONS FOR SELECTED ITEMS APPEAR IN SEPARATE INSTRUCTION BOOKLET AS INDICATED. REFER TO <br /> BOOKLET BEFORE FILLING OUT THESE ITEMS. <br /> Please Print or Type <br /> 1• Legal Name of Applicant 101 1 CITY OF MANTECA <br /> is"instructions) <br /> 2. Mailing Address o4 Applicant <br /> (see instructions) 1001 WEST CENTER ST. <br /> Number i Street 1928 <br /> MANTECA <br /> city 192® <br /> state 1020 CALIFORNIA. ' <br /> z10 Code t®sa 95® <br /> S. `Applicant's Authonaea Agent <br /> (see instructions) DAVID JINKENS <br /> Name dna Title 1038 <br /> CITY MANAGER <br /> Nur oer s.Street <br /> 1030 1001 WEST CENTER ST. <br /> City 1030 MANTECA <br /> State <br /> Shad CALIFORNIA <br /> Z ip Code 1028 95336 <br /> Telephone losf (209) 239-8400 <br /> .- Area Numoer <br /> 4. Previous Application Code <br /> It a previous application for a per• <br /> mit under the National Pollutant <br /> Discharge Elimination System has 84 26 <br /> peon mace,give the date of <br /> application. 104 YR MO DAY <br /> I cenity that am famillar with the information contained in this t00iication and that t0 the gest 04 my knOWleOge and Oellet Such information <br /> is tale,complete.and accurate. <br /> DAVID JINKENS 19241 CITY MANAGER <br /> Printed Name Ol Person Signing Title <br /> 31 0-zi <br /> 10211 YR MO DAY <br /> si Lure of Applicant Or Authorized ent Date AsipticatlOn Signed <br /> 18 Us.0 Section 1001 protides that: <br /> Whoever,in any matter within the jurisdiction of any department or agency of the United States knowinglt•and ttwilf ollr falsifies.conceals Of <br /> corers up by any trick,scheme,or de•tce a material fact,or makes am false.fictutmis or frardident statement or represenrotion,or makes or <br /> uses any Joist writing ortdocument knowing seine to confetti any false.fictitious or frdudulenr statement or entry.shall be fined not more than <br /> 510.000 or imprisoneq.not more than five years,or both. <br /> FOR AGENCY USE <br /> OFFICE: ..EPA Region Number <br /> Stats <br /> Received <br /> — <br /> YR MO DAY <br /> I-I Thit• section contains 4 <br /> gra Form 753L—i2 <br />