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State of California-Environmental Protection Agenc Department of Toxic Substance Control <br /> FOR OFFICIAL USE ONLY /UI <br /> DTSC REGIONAL OFFICE <br /> TEMPORARY HOUSEHOLD HAZARDOUS WASTE U� PO <br /> COLLECTION FACILITY �N�//RO 200 <br /> PERMIT BY RULE NOTIFICATION SF T yF <br /> Rt1/o, s Ty <br /> For use by agencies operating a Temporary Household Hazardous Waste Collection Facility (THHWCF) under Permit By <br /> Rule. Each location requires a separate form. <br /> XD INITIAL NOTIFICATION F-1 REVISED NOTIFICATION Put an <br /> asterisk in the left margin next to the <br /> revised information. <br /> L GENERAL INFORMATION <br /> A. FACILITY ID NUMBER CAH111000526 <br /> B. FACILITY NAME North County Recycling Center <br /> C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br /> LOCATION <br /> ADDRESS 17720 East Harney Lane <br /> CITY Lodi CA ZIP CODE 95376 - <br /> COUNTY San Joaquin <br /> D. OPERATOR(PUBLIC AGENCY) <br /> AGENCY NAME County of San Joaquin Department of Public Works <br /> MAILING ADDRESS P.O.Box 1810, 1810 East Hazelton <br /> CITY Stockton CA ZIP CODE 95201 - <br /> COUNTY San Joaquin <br /> E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br /> CONTACT PERSON Hudson Alison <br /> (LAST NAME) (FIRST NAME) <br /> PHONE NUMBER (209)468-3066 <br /> DTSC 8464(10/97) Page ❑ of 4 <br /> FS/ADMINFORMS\PBR FORM <br />