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FACILITY NAME Park and Ride Parking Lot <br />ID NUMBER CAH 111000598 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />F. CONTRACTOR INFORMATION (if applicable) <br />NAME MSE Environmental, Inc. <br />MAILING ADDRESS 880 West Verdulera Street <br />CITY <br />Camarillo CA ZIP CODE 93010 - <br />G. CONTRACTOR CONTACT PERSON INFORMATION (if applicable) <br />CONTACT PERSON Drake Jessica <br />(LAST NAME) (FIRST NAME) <br />PHONE NUMBER (805) 987-0217 <br />H. ACCEPTANCE OF COMMERCIAL WASTES <br />YES NO <br />© ❑ Will your facility accept wastes from small quantity commercial source generators? <br />I. <br />J. <br />THE FOLLOWING LOCAL AUTHORITIES HAVE BEEN NOTIFIED OF THE <br />INTENDED OPERATION OF THE THHWCF: <br />Environmental Management <br />Fire Department <br />Law Enforcement <br />Traffic <br />Air Quality <br />THE FOLLOWING LOCAL PERMITS HAVE BEEN OBTAINED FOR OPERATION <br />OF THE THHWCF: <br />No local permits required. <br />DTSC 8464 (9/92) Page 2 of 4 <br />F&ADMINFORMSTBR FORM <br />