Laserfiche WebLink
SAN 10 A Q U I N Environmental Health Department <br /> - ----COUNTY- <br /> UNIVERSAL WASTE AEROSOL CAN PROCESSING NOTIFICATION <br /> I. FACILITY INFORMATION <br /> FACILITY NAME: EPA ID NUMBER: <br /> /4e.-c keAros 9731 <br /> LOCATION/MAILING ADDRESS: FACILITY PHONE NO: <br /> S 9,U9-'4?--q6_70 <br /> CITY: ZIP CODE: <br /> FACILITY CONTACT NAME: CONTACT PHONE NO: <br /> noire,- Av ZUq-��Z-967U <br /> H. PROCESS DESCRIPTION <br /> TYPE OF AEROSOL CANS: <br /> IUM�nJnn Skeet Iasi. <br /> ESTIMATED VOLUMES OR QUANTITIES TO BE PROCESSED MONTHLY: <br /> 2 <br /> TREATMENT PROCESS OR PROCESSES DESCRIPTION: <br /> EM c n«, r6k4eJu J Iec r f-ea _ kree.-i <br /> EQUIPIMENT DESCRIPTION: <br /> >S t S 5 e <br /> EQUIPMENT DESIGN CAPACITIES: <br /> on <br /> III. HAZARDOUS WASTE TREATMENT RESIDUALS <br /> DESCRIPTION OF THE CHARACTERISTICS OF HAZARDOUS TREATMENT RESIDUALS: <br /> H nC S!e i,, soured iti ci -ruin- <br /> DESCRIP ION OF MANAGEMENT OF ANY HAZARDOUS TREATMENT RESIDUALS: <br /> (* 1 C�Ck4tt kleen Ly.!l h v (v., Un , e,+ <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 property gather and evaluate the information submitted.Based on my inquiry of the person or persons <br /> who manage the system,or those persons directly responsible for gathering the information,the information submitted is,to be the best of my <br /> knowledge and belief,true,accurate,and complete.I am aware that there are significant penalties for submitting false information,including the <br /> ssibility of fine and imprisonment for knowing violations. <br /> SIGNATURE*: DATE: <br /> 4 . G---7 <br /> NAME OF fi PERSON <br /> /^11GNIN CER (CATION(PRINT): TITLE: <br /> fe l�l L! e 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 <br /> principal business function,or any other person authorized to perform similar policy or decision-making functions,which govern the operation <br /> of the regulated 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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />