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07/11/96 THU 11:08 FAX 707 747 7705 PHILIP ENVIROMENTAL 10006 <br />State of Callrornia - Envirnamental rrotectlon ACracr Departwcut of Toxic Subslroces Control <br />For Official Use Only <br />DTSC Regional Office <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />For use by agencies operating a Temporary Household Hazardous Waste Collection Facility (THHWCF) <br />under Permit By Rule. Each location requires a separate form. <br />O INITIAL NOTIFICATION O REVISED NOTIFICATION Put an asterik <br />in the left margin next to the revised <br />information. <br />I. GENERAL INFORMATION <br />A. FACILITY ID NUMBER CAH111000284 <br />B. FACILITY NAME Escalon Community Center <br />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY LOCATION <br />Address 1050 Escalon Ave. <br />City Escalon, CA Zip Code 95230 <br />County San Joaquin <br />D. OPERATOR (PUBLIC AGENCY) <br />Agency name San Joaquin County Dept. Of Public Works <br />Mailing Address 1810 East Hazelton <br />City Stockton, CA Zip Code 95201 <br />County San Joaquin <br />E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />Contact Person Alison Hudson <br />Phone Number (209)468-3066 <br />DTSC 8464 (9192) Page 1 of 4 <br />