COMPLIANCE INFO_1995-2008 - Laserfiche WebLink

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Page 5 CALIFORNIA ENVIRONMENTAL State of California socncs PROTECTION AGENCY Regional Water Quality Control Board `¢ f APPLICATION/REPORT WASTE DISCHARGE m GENERAL INFORMATION FORM FOR � s' WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT �LlIORKs' . A Rarility• I. FACILITY INFORMATION R_ Facilitv Owner: Name: - French Camp RV Park and Golf Course Canada Cove, LLP Address: 3. ❑ Governmental 4. ❑✓ Partr�rship _ 3919 E. French Camp Rd Address: City; County: State: Zip Code: Manteca San Joaquin CA 95336 Contact Person: 95231 Telephone Number: Jack Verderame Telephone Number:Federal (209) 234-3001 R_ Facilitv Owner: Name: City: Owner Type (Check One) 1' ❑ zn,Iivi� 2 ❑ C rp°rar, on Canada Cove, LLP French Camp ; 3. ❑ Governmental 4. ❑✓ Partr�rship _ Address: Address: P.O. Box 1500' f Jack Verderame Agency I ❑ Other: City: state: zip Mode: French Camp CA 95231 95231 Contact Person: - Telephone Number:Federal Tax ID: Jack Verderame (209) 234-3001 (209) 234.3001 94-2706173 Facility Operator (The agency or business, not the person: Naga: City: Operator Type (Check one) Canada Cove, LLP French Camp ; 3- ❑ r' a la..l, 3. Governmental 2 ❑ 4. Partnership Address: P.O. Box 1500 f Jack Verderame Agency City: city: State: Zip Coda: French Camp CA 95231 5. Contact Person: Jack Verderame Telephone Number: (209) 234-3001 Jack Verderame (209) 234-3001 D. Owner of the,Land: Name: City: Type (Check One) 3- 0 x-&-id-1 z ❑ a-1—it:3— Canada Cove, LLP French Camp ; 3. ❑ Governmental 4- 21 Partnership Address: - Contact Person: P.O. Box 1500 f Jack Verderame Agency ❑ City: State: zip Cade: French Camp CA 95231 Contact Person: Telephone Number. Jack Verderame (209) 234-3001 E. Address Where Legal Notice May Be Served: Address: 3919 E. French Camp Rd. City: Grate: Zip code: Manteca CA 95336 � Contact Person: Tel hone Ntmber: Jack Verderame 20 234-3009 F. Billing Address: Address: P.O. Box 1500 City: Stats: Zip Code: French Camp ; CA 95231 Contact Person: Telephone Number: - f Jack Verderame (209) 234-3001 V.— ZODi6/971