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A <br />FACILITY NAME Escalon Community Center <br />ID NUMBER CAHI 11000284 <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 />If not, a written agreement between the operator and the property owner is required. <br />City of Escalon / Thom Clark, City Manager <br />PROPERTY OWNER'S NAME <br />PHONE NUMBER 209-939-3556 <br />II. DAYS AND HOURS OF OPERATION <br />Show hours using a 24-hour clock. Example: Ipm should be shorn as 1300. <br />PLANNED DATES HOURS <br />Month/Day/Year <br />Open Close <br />09 / 16 / 00 <br />09 00 15 00 <br />DTSC 8464 (9/92) <br />FS/ADMINFORMSIPBR FORM <br />Page 3 of 4 <br />