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FACILITY NAME Payless Food Mart Parkine Lot <br />ID NUMBER CAH111000595 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />K. IS THE PROPERTY ON WHICH THE THHWCF WILL BE HELD OWNED <br />BY THE OPERATOR? <br />YES NO <br />FX If not, a written agreement between the operator and the property owner is required. <br />PROPERTY OWNER'S NAME Harry L. Young & Sons, Kenneth Young <br />PHONE NUMBER (209) 727-5551 <br />II. DAYS AND HOURS OF OPERATION <br />Show hours using a 24-hour clock. Example: Ipm should be shown as 1300. <br />PLANNED DATES HOURS <br />Month/Day/Year Open Close <br />08 / 21 / 99 06 00 18 00 <br />DTSC 8464 (9/92) Page 3 of 4 <br />FS/ADMINFORMS\PBR FORM <br />