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h <br />FACILITY NAME Payless Food Mart Parking Lot <br />ID NUMBER CAH 111000595 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />K. IS THE PROPERTY ON '*VHICH THE THHWCF WILL BE HELD OWNED <br />BY THE OPERATOR? <br />YES NO <br />LJ FXI If not, a written agreement between the operator and the property owner is required. <br />PROPERTY OWNER'S NAME KENNETH ''i dung <br />PHONE NUMBER 209-7t7-5551 <br />II. DAYS AND HOURS OF OPERATION <br />Show hours using a 24-hour clock. Example: Ipm should be sho-n as 1300. <br />PLANNED DATES HOURS <br />Month/Day/Year Open Close <br />08 / 26 / 00 06 00 18 00 <br />Page of 4 <br />DTSC 8464 (9/92) <br />FS(ADMINFORMS\PBR FORM <br />