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rACILITY NAME Pscalon Community CenterD NUMBER AHI 11000284 �. ......... . <br />.................. --- ......... . ....... - ........ . .............. . ...................... . ..... . .......... ......................... . . ............... L 1C ... ......... . .......... . ....................... <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />F. CONTRACTOR INFORMATION (if applicable) <br />NAME <br />MSE Environmental, Inc. <br />(LAST NAME) <br />(FIRST NAME) <br />MAILING ADDRESS <br />880 West Verdulera Street <br />PHONE NUMBER (805) 987-0217 <br />rITY <br />r.. ama . r - i .. I .. I .. o <br />CA ZIP CODE 3010 <br />.... . ...... . ........... ............. <br />G. CONTRACTOR CONTACT PERSON INFORMATION (if applicable) <br />CONTACT PERSON Oldemeyer <br />anice <br />(LAST NAME) <br />(FIRST NAME) <br />PHONE NUMBER (805) 987-0217 <br />H. ACCEPTANCE OF COMMERCIAL WASTES <br />YES NO <br />JXJ I I Will your facility accept wastes from small quantity commercial source generators? <br />I. THE FOLLOWING LOCAL AUTHORITIES HAVE BEEN NOTIFIED OF THE <br />INTENDED OPERATION OF THE THHWCF: <br />JXJ I Environmental Management <br />JXJ I Fire Department <br />JXJ I Law Enforcement <br />JXJ I Traffic <br />X Air Quality <br />. . ........... <br />.................. . . .......... ---------- <br />THE FOLLOWING LOCAL PERMITS HAVE BEEN OBTAINED FOR OPERATION <br />OF THE THHWCF: <br />ro local permits required. <br />. . . . ...... <br />... . . . ............. . .... . . . .... <br />DTSC 8464 (9/92) Page 0 of 4 <br />FS/ADMINFORMS\PBR FORM <br />