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State of California -Environmental Protection Agency <br />FOR OFFICIAL USE ONLY <br />v H <br />Department of Toxic Substance Control <br />DTSC REGIONAL OFFICER <br />� ^ M <br />„� � D <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE ((�" <br />COLLECTION FACILITY MAY 2 3 2002 <br />PERMIT BY RULE NOTIFICATION <br />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 INITIAL NOTIFICATION REVISED NOTIFICATION Put an <br />asterisk in the left margin next to the <br />revised information. <br />I. GENERAL INFORMATION <br />A. <br />FACILITY ID NUMBER <br />CAH 111000527 <br />COUNTY San Joaquin <br />B. <br />FACILITY NAME <br />Thornton New Hope School Parking Lot <br />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />ADDRESS 26675 N. Sacramento Rd. <br />CITY Thornton CA ZIP CODE 95686 <br />COUNTY San Joaquin <br />D. OPERATOR (PUBLIC AGENCY) <br />AGENCY NAME County of San Joaquin Department of Public Works <br />MAILING ADDRESS 1810 East Hazelton <br />CITY Stockton CA ZIP CODE 95201 <br />COUNTY San Joaquin <br />E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />CONTACT PERSON DiCiano Jennifer <br />LAST NAME) FIRST NAME) <br />PHONE NUMBER 209) 468-3066 <br />DTSC 8464 (9/92) Page ❑ of 4 <br />FS/ADMINFORMS\PBR FORM <br />