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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 EAST HAZELTON AVENUE, STOCKTON, CA 95205 <br />(209) 468-3420 FAX (209) 468-0138 <br />APP 2 9 2019 <br />ENVIRONNIEN'1'AL HEALTH <br />DEPARTMENT <br />UNIVERSAL WASTE AEROSOL CAN PROCESSING NOTIFICATION <br />This notification shall be submitted in person or by certified mail, with return receipt requested <br />I. FACILITY INFORMATION <br />FACILITY NAME: <br />EPA IQ <br />©00e S <br />(C"I`S1O� <br />(a <br />LOCATION/MA LING ADDRESS: <br />FACILITY PH NE NO: <br />� -0 O \0 � <br />0,0 t ��22 3 00 <br />CITY: <br />C..4 3 o q <br />ZIP CODE: <br />a S 3o,4 <br />FACILITY CONTACT NAME: <br />O: <br />CONTACT PHONE NNAt <br />IV C5 `! <br />, U <br />1 V\ <br />II. PROCESS DESCRIPTION <br />TYPE OF AEROSOL CANS: <br />p <br />eqW �� / , �� �r,`vu e.�/ �Yt1�►( �ci?-CJY� �. <br />ESTIMATED VOLUMES OR QUANTITIES TO BE PROCESSED MONTHLY: <br />45 4o O Ca <br />TREATMENT PROCESS OR PROCESSES DESCRIPTION: <br />EQUIPMENT DESCRIPTION: <br />A e Yo <br />EQUIPMENT DESIGN CAPACITIES: <br />l ©� CO <br />III. HAZARDOUS WASTE TREATMENT RESIDUALS <br />DESCRIPTION OF THE CHARACTERISTICS OF HAZARDOUS TREATMENT RESIDUALS: <br />r" k�/ \ o P�� (a�' <br />cL g <br />DESCRIPTION OF MANAGEMENT OF ANY HAZARDOUS TREATMENT RESIDUALS: <br />�- <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, an p e e, m aware that there are significant penalties for submitting false information, including the possibility of fine and <br />imprisonment for kno olations. <br />SIGNATURE': <br />DATE: <br />J <br />NAME OF P`f I GCERTIFICATION (PRINT): <br />TITLE: <br />� <br />V �``A %�/\ �r7'V�q " <br />C) <br />"Note: Per the CA Code of Regulations, Title 22, section 66270.11, this notification must be signed as 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 principal geographic unit of thea enc (e.g., Regional Administrators of USEPA . <br />