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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 EAST HAZELTON AVENUE, STOCKTON, CA 95205 OCT 3 0 1_'C','0 <br /> (209) 468-3420 FAX (209) 468-0138 <br /> ENVIRONMENTAL HEALTH <br /> UNIVERSAL WASTE AEROSOL CAN PROCESSING NOTIF�IC'►jj/6I1VICES <br /> This notification shall be submitted in person or by certified mail,with return receipt requested <br /> I. FACILITY INFORMATION <br /> FACILITY NAME: 1 D EPA ID NUMBER: <br /> Tac � Coa8�t' J"ro�ucrs <br /> LOCATION/MAILING ADDRESS: FACILITY PHONE NO: <br /> � <br /> 6 5D s. � C?-,pC)) 5- �9 82 <br /> CITY: ZIP CODE: <br /> L D�i <br /> '235 2-cl <br /> FACILITY CONTACT NAME: �� n�Qn' � I� CONTAC�2UVT?k PHONE NO: <br /> II. PROCESS DESCRIPTION <br /> TYPE OF AEROSOL CANS: f <br /> Fvocl rvl-e. �br f c.xn-I-s , sP p a 1 n <br /> ESTIMATED VOLUMES OR QUANTITIES TO BE PROCESSED MONTHLY: <br /> DiSpO— <br /> TREATMENT PROCESS OR PROCESSES DESCRIPTION: 1 Cyr ` <br /> Awospi Can I-eC�c�/ng pw= 1u �fiv+ f7kS CAWS. <br /> EQUIPMENT DESCRIPTION: 7--v P,ec¢ <br /> �fWW �os� tsci/�1 /[+' <br /> c Np4'wes odors an<< polo 44i 4 l Actr 1j4v/ <br /> EQUIPMENT DESIGN CAPACITIES: CPA PU � '�� Ca*i AAW //e .5 �t �• /1 CA <br /> III. HAZARDOUS WASTE TREATMENT RESIDUALS <br /> DESCRIPTION OF THE CHARACTERISTICS OF HAZARDOUS TREATMENT RESIDUALS. <br /> 1 yi+4j; li �w►� Y1,C1` <br /> DESCRIPTION OF MANAGEMENT OF ANY HAZARDOUS TREATMENT RESIDUALS: <br /> res+,e- (M duA k Arc 401-e-&k as-9;k cw-o rZ,, <br /> L-rJY)�r�n�iJ tr <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 aware that there are significant penalties for submitting false information, including the possibility of fine and <br /> imprisonment for knowing violation <br /> SIGNATURE': DATE: <br /> /o//s -'Zo 20 <br /> NAME OF PERSON SIGNING CERTIFICPTION( RINT): TITLE: <br /> SfC aAie. F'0,1(e, Cts 5bverVISores S <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 />