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Stale 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 />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />ADDRESS Shima Lot #2, 5151 Pacific Ave. <br />ITY Stockton <br />CA ZIP CODE <br />95207 <br />ILING ADDRESS <br />1810 East Hazelton <br />COUNTY San Joaquin <br />W OPERATOR (PUBLIC AGENCY) <br />GENCY NAME <br />rounty of San Joaquin Department of Public Works <br />95201 <br />ILING ADDRESS <br />1810 East Hazelton <br />ITY Stockton <br />CA ZIP CODE <br />95201 <br />COUNTY San Joaquin <br />E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />CONTACT PERSON Hudson Alison <br />_._._........._.... _._.._.......... _........ I._ ..... ................. - ..................1....11...11..................... <br />LAST NAME)(FIRST NAME) <br />HONE NUMBER (209) 468-3066 <br />DTSC 8464 (9/92) Page of 4 <br />FS/ADMINFORMS\PBR FORM <br />