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1 ' <br />State of California - Environmental Protection Agency Department of Toxic Substance Control <br />FOR OFFICIAL USE ONLY <br />DTSC REGIONAL OFFICE <br />TEMPORARY HOUSEHOLD I HAZARDOi1S 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 />FX INITIAL NOTIFICATION F-1 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 CAH 111000318 <br />B. FACILITY NAME Salas Park Parking Lot <br />C . FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />ADDRESS 2001 South Stockton Street <br />CITY <br />COUNTY <br />Lodi <br />San J <br />D . OPERATOR (PUBLIC AGENCY) <br />CA ZIP CODE 95240 - <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 Joaauin <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 (9/92) Page 1 of 4 <br />FSIADMINFORMS\PBR FORM <br />