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monk I <br />TEMPORARY HOECE'VED, <br />USEHOLD HAZARDOUS W E <br />( COLLECTION FACILITY DEC 2 9 2014. <br />PERMIT BY RULE NOTIFICATION <br />ENVIRONMENTAL HEALTH <br />F. CONTRACTOR INFORMATION (if applicable) DEPARTMENT <br />NAME 21st Century Envl Mqmt of CA, LP <br />MAILING ADDRESS 11855 White Rock Road <br />CITY Rancho Cqd STATE CA ZIP 95742 <br />G. CONTRACTOR CONTACT PERSON INFORMATION (if applicable) <br />CONTACT PERSON Winkler 'Marc <br />(LAST NAME) (FIRST NAME) <br />PHONE NUMBER 916.500.1884 <br />H. ACCEPTANCE OF CESQG WASTES <br />YES NO <br />❑✓ ❑ Will your facility accept wastes from conditionally exempt small quantity generators? <br />I. THE FOLLOWING LOCAL AUTHORITIES HAVE BEEN NOTIFIED OF THE INTENDED <br />OPERATION OF THE THHWCF: <br />Environmental Management <br />❑✓ Fire Department a <br />0 Law Enforcement _ <br />❑✓ Traffic <br />❑✓ Air Quality <br />J. THE FOLLOWING LOCAL PERMITS HAVE BEEN OBTAINED FOR OPERATION OF THE <br />THHWCF: <br />N/A <br />PAGE 2 OF 4 <br />DTSC 8464 (revised 10/07) <br />