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State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> TEMPORARY HOUSEHOLD HAZARDOUS WASTE RECEIVED <br /> COLLECTION FACILITY <br /> PERMIT BY RULE NOTIFICATION DEC 2 9 2014 <br /> For use by public agencies operating a Temporary Household Hazardous Waste Collection Facility(THHWCF)under Permit By Rule.Each location requires a <br /> separate form. EWRONMENTALHMTH <br /> /RE 1nCES <br /> Q INITIAL NOTIFICATION ❑REVISED NOTIFICATION Put an asterisk in the left margin next to the revised <br /> information <br /> I. GENERAL INFORMATION <br /> A. FACILITY ID NUMBER CAH 111000284 <br /> B. FACILITY NAME Escalon Community Center <br /> C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY LOCATION <br /> ADDRESS 1055 Escalon Avenue <br /> CITY Escalon STATE CA ZIP 95320 <br /> COUNTY San Joaquin <br /> D. OPERATOR(PUBLIC AGENCY) <br /> AGENCY NAME San Joaquin County <br /> Department of Public Works <br /> MAILING ADDRESS P.O. Box 1810, 1810 E. Hazelton Avenue <br /> CITY Stockton STATE CA ZIP 95201 <br /> COUNTY San Joaquin <br /> E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br /> CONTACT PERSON Moberly Elisa <br /> (LAST NAME) (FIRST NAME) <br /> PHONE NUMBER 209.468.3066 <br /> DTSC 8464(revised 10/07) PAGE 1 OF 4 <br />