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MIK <br />t ^.A _ . T . !_ Llf l 1� ' _'_Ik ID I PST' 09 4687-078 P.06 <br />m *� <br />,. e <br />State of C.allfornia - Envir to I Protection Agency C Anent of Toxic SubsiaulCeg Control <br />u, For Official Use Only; ' (( <br />�DTSC Regoual OffiCe <br />TEMPORARY HOUSEHOLD HAZARDOUS % A.STE <br />COLLIECTION FACILITY <br />PERNQT BY RULE NorITFIC,NTIQN <br />For use by agencies c,peratina a "I'Gctpnraty Hausenc:ld Ilazardous Waste CollectlOn Facility t TIIHN'CF) <br />Linde: Permit By Rule Lich location requires a separate form. <br />;q L�iITIAL NOTIFICATION El REVISED NOTIFICATION Pit anasterisk <br />in the left mar -n next to :he : evised <br />information <br />GEIv"ERAI. L'vFOR-MATION <br />A FACILITY ID NL`'NTBER CA.H 111000491 <br />B FACILITY NTAXT- East Side Community Park <br />C t ACMITY ADt)RESS OR LEGAL DFSc R-WTIOIN OF FA( Ii_1 l') LOCATION <br />Address 5254 Ardelle Ave <br />cit" Stockton, CA Zip Code 95205 <br />County San Joaquin <br />D OPERATOR ( Pt: BLIC AGE`4- j <br />Agency na ne San Joaquin County, Dept of Public \Norks <br />Mailing :address P.O. Bog 1810 <br />Ciry Stockton Zip Code 95201 <br />County San Joaquin <br />E OPER-ATOR/AGUNCY COI7-kCT PERSON LVFORMA IION <br />Contact Person Alison Hudson <br />')hone Numb;r (209)468-3066 <br />-DISC 8464 (9192 ) <br />Page I of 4 <br />