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State of California - Environmental Protection Ag <br />FOR OFFICIAL USE ONLY <br />DTSC REGIONAL OFFICE <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />Department qLXevir-S4rhfiL4Dcc Control <br />S � <br />w-4 <br />Q <br />w �l°,i02a°�j <br />S,7 <br />T ATE OF r: <br />CALL=ORR;!,a., /1 <br />EPA j <br />For use by agencies operating a Temporary Household Hazardous Waste Collection Facility (THHWCF) under it��fZ <br />location requires a separate form. <br />XX INITIAL NOTIFICATION ❑ REVISED NOTIFICATION Put an <br />asterisk in the left margin next to the <br />revised information. <br />I. GENERAL INFORMATION <br />A. FACILITY ID NUMBER CAH111000526 <br />B . FACILITY NAME North County Recycling Center <br />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />ADDRESS 17900 East Harney Lane <br />CITY Lodi <br />COUNTY San Joaquin <br />D . OPERATOR (PUBLIC AGENCY) <br />CA ZIP CODE 95376 - <br />AGENCY NAME County of San Joaquin Department of Public Works <br />MAILING ADDRESS P.O. Box 1810, 1810 East Hazelton <br />CITY Stockton CA ZIP CODE 95201 - <br />COUNTY San Joaquin <br />E . OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />CONTACT PERSON Hudson Alison <br />(LAST NAME) (FIRST NAME) <br />PHONE NUMBER (209) 468-3066 <br />DTSC 8464 (10/97) Page 1 of 4 <br />FS/ADMINFORMS\PBR FORM <br />