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R r <br />State of California -Environmental Protection Agency Department of Toxic Substance Control <br />FOR OFFICIAL USE ONLY <br />ORIbINAL <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 />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />ADDRESS 1050 Escalon Avenue <br />ITY scalon CA ZIP CODE 95230 <br />COUNTY San Joaquin <br />D. OPERATOR (PUBLIC AGENCY) <br />AGENCY NAME ounty of San Joaquin Department of Public Works <br />ILING ADDRESS 1810 East Hazelton <br />ITY Stockton <br />CA ZIP CODE 95201 <br />- <br />COUNTY San Joaquin <br />E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />ONTACT PERSON Hudson Alison <br />_......................__....._............. _._ _.—._. _._... _... __.......... _...._..........._....- . ---...._.._._.__..._... <br />LAST NAME) FIRST NAME) <br />HONE NUMBER 209) 468-3066 <br />DTSC 8464 (9/92) Page o f 4 <br />FS/ADMINFORMSTBR FORM <br />