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s. <br />t <br />State of California - Environmental Protection Agency <br />FOR OFFICIAL USE ONLY <br />DTSC REGIONAL OFFICE <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />Department of Toxic Substance Control <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 />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />DDRESS 9633 S. Tracy Blvd. <br />ITY racy CA ZIP CODE <br />5376 <br />COUNTY San Joaquin <br />D. OPERATOR (PUBLIC AGENCY) <br />AGENCY NAME County of San Joaquin Department Of Public Works <br />ILING ADDRESS P.O. Box 1810, 1810 East Hazelton <br />l Stockton CA ZIP CODE 5201 <br />COUNTY San Joaquin <br />E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />DTSC 8464 (9/92) Page of 4 <br />FS/ADM INFORMS`PBR FORM <br />