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State of California -Environmental Protection .agency <br />FOR OFFICIAL USE ONLY <br />Department of Toxic Substance Control <br />DTSC REGIONAL OFFICE <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE MAY 2 3 2002 <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION ENVIRONMENT HEALTH <br />PERMIT/SERVICES <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 INITLAL NOTIFICATION TREVISED NOTIFICATION Put an <br />asterisk in the left margin next to the <br />revised information. <br />I. GENERAL INFORMATION <br />A. FACILITY ED NUMBER <br />CAH111000207 <br />B. ACILITY NAME <br />San Joaquin County Delta College Shima 2 Parking Lot <br />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />DRESS Shima Lot #2, 5151 Pacific Ave. <br />CITY Stockton CA ZIP CODE P5207 <br />COUNTY San Joaquin <br />ff <br />D. OPERATOR (PUBLIC AGENCY) <br />AGENCY NAME rounty of San Joaquin Department of Public Works <br />MAILING ADDRESS 11810 East Hazelton <br />ITY tockton ICA ZIP CODE 95201 <br />COUNTY an Joaquin <br />E. OPERATORIAGENCY CONTACT PERSON INFORMATION <br />CONTACTPERSON DiCiano Jennifer <br />LAST NAME) FIRST NA.�) <br />HONE NUMBER 209) 468-3066 <br />DTSC 8464 (9/92) Page of 4 <br />FS/ADMINFORMS\PBR FORM <br />