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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 EAST HAZELTON AVENUE, STOCKTON, CA 95245 <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 mail,with return receipt requested <br /> I, FACILITY INFORMATION <br /> FACILITY NAME: FACILITY <br /> ID NUMBER: <br /> K C CA L 00,40L 66 `Jq7)i <br /> LOC TIONIMA ONG ADDRESS. FACILITY PHONE NO: <br /> CiTr ZIP 50DE: <br /> -� 1]CTD r C 7,; 2- ( c,:) <br /> FACILITY CONTACT NAME; CONTACT PHONE NO: <br /> 11. PROCESS DESCRIPTION <br /> TYPE OF AEROSOL CANS. <br /> Various -paint,lubricants, and other household aerosols. <br /> ESTRATED VOLUMES OR QUANTITIES TO BE PROCESSED MONTHLY <br /> Approximately 10-20 cans per month. <br /> TA MENT pROCE55 OR PROCESSES DESCRIPTION <br /> Empty cans as much as feasible, contain in drum with proper label. <br /> -CQ—U-10 FAtfff DESCRIPTION. <br /> Steel Drum <br /> ECUr MENT DESIGN CAPACITIES: <br /> 30-or 55-gallon <br /> III. HAZARDOUS WASTE TREATMENT RESIDUALS <br /> DESC IPTION OF THE CHARACTERISTICS OF HA7-ARD4U$TREATMENT RESIDUALS: <br /> flammable,toxic <br /> ^bE5G IPTION OF MANAGEMENT OF ANY HAZARDOUS TREATMENT RESIDUALS: <br /> Vendor to manage Hazardous treatment residuals. <br /> IV. CERTIFICATION <br /> t cartrfy under penaf[y of Iaw that this document and all attachments were prepared under my direction or supervision In accordance with asyslem <br /> desr9r4d to assure that qualified personnel property gather and evaluate the information submitted. Based on my inquiry of the person or persons who <br /> mana&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,iriciuding the possibility of fine and <br /> rm rrso nt for knowing violations, <br /> SIGNATURE' <br /> PATE. <br /> • 12119/2018 <br /> N,AI.1E F:!PERS SS1-GN N TIFIiJ TION tPRINT). TITLE: <br /> S Av E-\y QpT+-� to, <f> )PLA- £ i'11v1�1C <br /> `Note:Per the CA Code of Regulations,Title 22,section 88270.11,this notification must be signed a4 follows: <br /> + For d corporation:by a responsible corporale 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 operatlon of the regulated <br /> foci 14Y.for the carporallon, <br /> For a parinershlp or sale proprietorship:by a general pariner or the proprietor,respeclively <br /> For 4 municipality, State. Federal, or other public agency: t,y either a principal executive officer or ranking eiected official. For purposes of this <br /> Becton,a principal executive officer of a Federal agency includes: the chief executive officer of the agency, or a senior executive officer having <br /> re%pinsibility for the overall op±rations of a principal a ra {c Wilt of thea ency(e-q..Regional Adminisirators of USEPAI. <br />