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• - 07/10/1998 15:54 8059878718 MSE EHVIPOHMEHTAL PAGE 06 <br />State of California • Environmental Protection Agency Department of Toxic substance Control <br />FOR OFFICIAL USE ONLY <br />nTSC RErIONAL 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) under Permit By Rule. Each <br />location requires a separate form. <br />❑X 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 CAHIII000595 <br />B. FACILITY NAME Payless Food Mart Parking Lot <br />C . FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />ADDRESS 18980 North Highway 88 <br />CITY Lockeford CA ZIP CODE 95236 - <br />COUNTY San Joaquin <br />D. OPERATOR (PUBLIC AGENCY) <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) <br />PHONE NUMBER (209) 468-3066 <br />DTSC 8464 (9/92) <br />PSIADMINFORMS\PB FORM <br />(FIRST NAME) <br />Page 1 of 4 <br />