Laserfiche WebLink
APPLICATION FOR HAZARDOUS WASTE ACTIVITY VARIANCE <br />RETURN TO: <br />HOUSEHOLD HAZARDOUS WASTE UNIT <br />State Regulatory Programs Division <br />Department of Toxic Substance Control <br />Berkeley, California 94710-2737 <br />Public Agency <br />Applicant: <br />County of San Joaquin <br />Contractor: <br />MSE Environmental, Inc. <br />Activity Location: <br />5151 Pacific Avenue <br />Contractor Address: <br />880 West Verdulera Street <br />City, State, Zip: <br />Stockton, CA 95207 <br />City, State, Zip: <br />Camarillo, CA 93010 <br />EPA ID #: <br />CAH 111 000 207 <br />Contractor EPA ID #: <br />CAD 982 504 953 <br />TYPE OF VARIANCE REQUESTED <br />Complete this application and submit with the information identified in the attached supporting documentation for variance <br />application to the above address. <br />A. TYPE OF VARIANCE (X) HHW ( ) CESQG ( ) Door to door ( ) Mobile ( )Other—_ <br />B. I am requesting a variance pursuant to California Health and Safety Code (HCS), section 25143 because the following <br />conditions apply: ATTACH SUPPORTING INFORMATION <br />( X ) The hazardous waste is solely a non-RCRA hazardous waste or the hazardous waste or its management is exempt <br />from, or is not otherwise regulated pursuant to the Resource Conservation and Recovery Act (RCRA); and meets <br />one or both of the findings listed below; and meets one or both of the findings listed below <br />( X ) The hazardous waste or the hazardous waste management activity is insignificant or unimportant as a potential <br />hazard to human health and safety and the environment because of its small quantity, low concentration and/or <br />physical or chemical characteristics; and/or <br />( ) The handling, processing, or disposal of the hazardous waste, or the hazardous waste management activity, is <br />regulated by another governmental agency in a manner that ensures it will not pose a substantial present or <br />potential hazard to human health and safety and the environment. <br />CERTIFICATION <br />I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in <br />accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. <br />Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the <br />information, the information submitted in this application and attachment is, to my knowledge and belief, true, accurate, and <br />complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine <br />and imprisonment for knowing violations. <br />Manual Lopez Director <br />(Name of Applicant and Title) <br />Alison Hudson <br />(Contact Person) (Please Print) <br />(209)468-3066 <br />(Phone Number) <br />(10/95) <br />fs/1483/deltacollepvarience6/99/tq <br />(Signatur�of plicant)(Date) <br />P.O. Box 1810, 1810 East Hazelton <br />(Address) <br />Stockton CA 95201 <br />(City) (State) (Zip) <br />