Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 EAST HAZELTON AVENUE, STOCKTON, CA 95205 <br /> (209) 468-3420 FAX (209) 468-0138 <br /> UNIVERSAL WASTE AEROSOL CAN PROCESSING NOTIFICATION <br /> This notification shall be submitted In person or by certified mall,with return receipt requested <br /> I. FACILITY INFORMATION <br /> FACILITY NAME: EPA ID NUMBER: <br /> C ut r SC'eF (?At 000349!Z)h <br /> LOCATION/MAILING ADDRESS: FACILITY PHONE NO: <br /> zzyNPIV *tip z09-9.�8-a <br /> CITY: ZIP CODE: <br /> FACILITY CONTACT NAME: CONTACT PHONE NO: <br /> M r� os h ZOf- -33 <br /> II. PROCESS DESCRIPTION <br /> TYPE OF AEROSOL CANS: <br /> -- (2`Ct� i tD n2 <br /> ESTIMATED VOLUMES OR QUANTITIES TO BE PROCESSED.MONTHLY: <br /> . � C' Mt�•a'�`� <br /> 7REATME PROCESS Q OCESSf.S <br /> WTI <br /> +.DS w� 1 3 > G'xt t. L� `t"o >wr W i1► Go;.Jb Sa c <br /> EQUUInIP�n,M��E.N,1T��Ut:IUKIPTION: -V� <br /> +ice(' M 1Z., <br /> EQUIPMENT DESIGN CAPACITIES:: <br /> -Dc'C 5s &Al\c..3 ZP.um <br /> III. HAZARDOUS WASTE TREATMENT RESIDUALS <br /> DESCRIPTION OF THE CHARACTERISTICS OF HAZARDOUS TREATMENT RESIDUALS: <br /> AWN <br /> DESCRIPTION OF MANAGEMENT OF ANY HAZAROOUSTREATMENT RESIDUALS: S <br /> IV. CERTIFICATION <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system <br /> designed to assure that qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who <br /> manage the system,or those persons directly responsible for gathering the Information,the Information submitted is,to be the best of my knowledge and <br /> belief,true,accurate,and complete. I am a that there are significant penalties for submitting false information,Including the possibility of fine and <br /> int rkarmlent for viola <br /> SIGNATURE•: DATE; <br /> 9- //- 13 <br /> NAME OF P.RSO SIGNING CERTIFI T N(P T); TITLE: <br /> •Nolo:Per the C. Co�fR Regulations, <br /> Title 22,soc ion 662701,this notification must be signed Be follows:^ <br /> . For a corporation:by a responsible corporate officer,e.g.president,secretary,treasurer, or vice-president of the corporation In charge of a principal <br /> business function,or any other person authorized to perform similar policy or decision-making functions,which govern the operation of the regulated <br /> facility,for the corporation. <br /> . For a partnership or sole proprietorship:by a general partner or the proprietor,respectively <br /> . For a municipality, State, Federal. or other public agency: by either a principal executive officer or ranking elected official. For purposes of this <br /> section, a principal executive officer of a Federal agency includes: the chief executive officer of the agency, or a senior executive officer having <br /> responsibility for the overall operations of a Lnncipal geographic unit of g+e a en e. .,Rookmal Administrators of USEPA. <br />