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MUNICIPAL UTILITIES DEPARTMENT D d <br /> REGIONAL WASTEWATER CONTROL FACILITY <br /> 4A 2500 NAW DRIVE <br /> SIDCKTDN, CALIFORNIA 95206 <br /> (209)837-8750 Part A - Application /Permit <br /> CITY OF STOCKTON FAX: (209)937-8708 <br /> SECTION 1. APPLICATION <br /> Return the completed application by: <br /> Further Instructions: See reverse side. <br /> Al. Applicant Business Name I ESp0)e I -T n< um CO2 Po/1 Ar)0AJ <br /> A2. Address of premise discharging wastewater: -ECSO Ro &614 $T,V2 ja r 7_QZMIA) L- <br /> A. Street 3003 NAVY DiZIVE <br /> City 5 i oC&,�Tv N (A _ Zip `1 <br /> 1 <br /> A3. Business Address <br /> A. Street 300 Navy Dalve- <br /> City S7rICKTOi Cf, Zip 9 S2J � <br /> B. Mailing g 1 <br /> CKT- State t' Zip <br /> City 5 T _ <br /> A4. Chief Executive Officer <br /> A. Name PAJIA iAyL 0/L B. Title TL- Y�AIIAIRL MGA. <br /> C. Mailing Address PO R^x Lcl D. City 5'otKTOA State Ctk Zip q 5Z O 1 <br /> A5. Person to be contacted about this application <br /> A. Name R .5-.� I Ci,,Ko 3Ky B. Title Sell l0r 6907 IMAIL'.1Lc0, Phone <br /> A6. Person to be contacted in case of emergency n <br /> A. Name DAV IO i A7✓12 B. Title TE2rllINAL Y�IAA/ ALiLyL <br /> Day Phone204�(,a(n— `M 0- Night Phone Z01) - `7 9'6r - 7 LI Z <br /> A7. CERTIFICATION Icertify that the information above and on the following parts is true and correct <br /> to the best of my knowledge. <br /> Signature Date <br /> Print Name Title <br />