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TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br /> COLLECTION FACILITY <br /> PERMIT BY RULE NOTIFICATION <br /> F. CONTRACTOR INFORMATION(if applicable) <br /> NAME Clean Earth Environmental Solutions,d <br /> MAILING ADDRESS 933 First Avenue, Suite 200 <br /> CITY Kinq of Prt.n STATE PA ZIP 19406 <br /> G. CONTRACTOR CONTACT PERSON INFORMATION(if applicable) <br /> CONTACT PERSON Burchill Sean <br /> (LAST NAME) (FIRST NAME) <br /> PHONE NUMBER (949)441-6576 <br /> H. ACCEPTANCE OF CESQG WASTES <br /> YES NO <br /> In, ❑ 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 /> 0 Fire Department <br /> ❑✓ Law Enforcement <br /> 0 Traffic <br /> 0 Air Quality <br /> J. THE FOLLOWING LOCAL PERMITS HAVE BEEN OBTAINED FOR OPERATION OF THE <br /> THHWCF: <br /> DTSC 8464(revised 10/07) PAGE 2 OF 4 <br />