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State of California • Environmental Protection Agency <br />Department of Toiric Substance Control <br />FOR OFFICIAL USE ONLYR E <br />DTSC REGIONAL OFFICE <br />NI/IK 2 2000 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE ENVIROI,,, i'_ ''I A; , r wALTH <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION PERMIT / LhVIC ES <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 />Y INITIAL NOTIFICATION <br />I • GENERAL INFORMATION <br />A. FACILITY ID NUMBER <br />B. FACILITY NAME <br />CAH 111000324 <br />Tracy Corporation Yard <br />REVISED NOTIFICATION Put an <br />asterisk in the left margin next to the <br />revised information. <br />C . FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />ADDRESS 520 Tracy Blvd - <br />CITY Tracy CA ZIP CODE <br />95376 - <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 <br />PHONE NUMBER <br />Hudson <br />(LAST NA1ViE) <br />(209)468-3066 <br />Alison <br />(FIRST NAI'ME) <br />)TSC 8464 (9/92) Page 1 of 4 <br />VADMINFORMSTBR FORM <br />