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08/13%96 TUE 08:57 FAX 707 747 7705 PHILIP E:VVI OMENTAL '. tjllt <br />of rox <br />F�'`J <br />ie <br />s <br />` State of California - Ew1p irop_ _ . �rotcctioo A�ncy Tal <br />tic �< <br />Sa <br />Departm1.� Su <br />For Official Use Only <br />DTSC Regional Office DI q UG <br />16! a <br />TEMPORARY HOUSEHOLD HAZARDOUS ASs,q <br />COLLECTION FACILITYpF'p <br />PERMIT BY RULE NOTIFICATION R�'fjyED <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 />0 INITIAL NOTIFICATION 0 REVISED NOTIFICATION Put an asterik <br />in the IeA margin next to the revised <br />information. <br />I. GENERAL INFORMATION <br />A. FACILITY ID NUMBER CAH777000845 <br />B. FACILITY NAME Tower Park Marina <br />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY LOCATION <br />Address 14900 W. Highway 12 <br />City Lodi, CA Zip Code 95242 <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 (9/92) Page 1 of 4 <br />