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ACILITY NAME Payless Food Mart Parking Lot D NUMBER AH 111000595 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />CONTRACTOR INFORMATION (if applicable) <br />AME <br />MSE Environmental, Inc. <br />LAST NAME) <br />FIRST NAME) <br />AILING ADDRESS <br />880 West Verdulera Street <br />HONE NUMBER 805) 987-0217 <br />ITY <br />ramarillo CA ZIP CODE P3010 <br />G. CONTRACTOR CONTACT PERSON INFORMATION (if applicable) <br />CONTACTPERSON Oldemeyer <br />Janice K. <br />LAST NAME) <br />FIRST NAME) <br />HONE NUMBER 805) 987-0217 <br />H. ACCEPTANCE OF COMMERCIAL WASTES <br />YES NO <br />Will your facility accept wastes from small quantity commercial source generators? <br />THE FOLLOWING LOCAL AUTHORITIES HAVE BEEN NOTIFIED OF THE <br />INTENDED OPERATION OF THE THHWCF: <br />X Environmental Management <br />X Fire Department <br />X Law Enforcement <br />X Traffic <br />X Air Quality <br />Jā€¢ THE FOLLOWING LOCAL PERMITS HAVE BEEN OBTAINED FOR OPERATION <br />OF THE THHWCF: <br />o local permits required <br />DTSC 8464 (9/92) Page ā‘ of 4 <br />FS/ADMINFORMS\PBR FORM <br />