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? State of California - Environmental Protection Agency Department of Toxic Substance Control <br />FOR OFFICIAL USE ONLY <br />DTSC REGIONAL OFFICE <br />TEMPORARY HOUSEHOLD HAZARDOUS 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 />X INITIAL NOTIFICATION REVISED NOTIFICATION Put an <br />asterisk in the left margin next to the <br />revised information. <br />I. GENERAL INFORMATION <br />ACILITY ID <br />NAME <br />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />DRESS 17900 E. Harney Lane <br />CITY odi <br />CA ZIP CODE <br />93012 <br />CA ZIP CODE 95201 <br />HONE NUMBER 209) 468-3066 <br />COUNTY Isan Joaquin <br />D. OPERATOR (PUBLIC AGENCY) <br />ITY <br />Alison <br />tockton <br />CA ZIP CODE 95201 <br />HONE NUMBER 209) 468-3066 <br />COUNTY <br />San Joaquin <br />E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />ONTACT PERSON Hudson <br />Alison <br />LAST NAME) <br />FIRST NAME) <br />HONE NUMBER 209) 468-3066 <br />DTSC 8464 (9/92) Page o f 4 <br />FS/ADMINFORMS\PBR FORM <br />