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BW: <br /> TEMPORARY HOUSEHOLD HAZARDOUS W <br /> COLLECTION FACILITY <br /> PERMIT BY RULE NOTIFICATION F f; <br /> ENVIROWN10,JAL HEALTH <br /> F. CONTRACTOR INFORMATION(if applicable) <br /> NAME 21st Century Envl Mqmt of CA, LP <br /> MAILING ADDRESS 11855 White Rock Road <br /> CITY Rancho Ccn STATE CA ZIP 95742 <br /> G. CONTRACTOR CONTACT PERSON INFORMATION(if applicable) <br /> CONTACT PERSON Winkler Marc <br /> (LAST NAME) (FIRST NAME) <br /> PHONE NUMBER 916.500.1884 <br /> H. ACCEPTANCE OF CESQG WASTES <br /> YES NO <br /> Q✓ ❑ Will your facility accept wastes from conditionally exempt small quantity generators? <br /> I. THE FOLLOWING LOCAL AUTHORITIES HAVE BEEN NOTIFIED OF THE INTENDED <br /> OPERATION OF THE THHWCF: <br /> ❑✓ Environmental Management <br /> ❑✓ Fire Department <br /> ✓❑ Law Enforcement <br /> Q✓ Traffic <br /> ❑✓ Air Quality <br /> J. THE FOLLOWING LOCAL PERMITS HAVE BEEN OBTAINED FOR OPERATION OF THE <br /> THHWCF: <br /> N/A <br /> DTSC 8464(revised 10/07) PAGE 2 OF 4 <br />