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State 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 <br />Rule. Each location requires a separate form. <br />INITIAL NOTIFICATION © REVISED NOTIFICATION Put an <br />asterisk in the left margin next to the <br />revised information. <br />I. GENERAL INFORMATION <br />A. FACILITY ID NUMBER CAH111000857 <br />B. FACILITY NAME Tracy Municipal Airport <br />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />* ADDRESS 5749 S. Tracy Blvd. <br />CITY Tracy CA ZIP CODE 95377 - <br />COUNTY San Joaquin <br />D. OPERATOR (PUBLIC AGENCY) <br />AGENCY NAME County of San Joaquin Department of Public Works <br />MAILING ADDRESS P.O. Box 1810, 1810 E. Hazelton Ave. <br />CITY Stockton CA ZIP CODE 95201 - <br />COUNTY San Joaquin <br />E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />CONTACT PERSON Andrews Kimbra <br />(LAST NAME) (FIRST NAME) <br />PHONE NUMBER 209.468.3066 <br />DTSC 8464 (9/92) Page of 4 <br />FS/ADMINFORMSTBR FORM <br />