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SANlJOAOU IN <br />-COUNTY- <br />Greatness grows here. <br />Environmental Health Department <br />1868 E. Hazelton Avenue <br />Stockton, California 95205 <br />T 209 468-3420 <br />F 209 468-0333 <br />www.sjgov.org/department/envhealth <br />Hazardous Waste Generator Closure Notification & Procedures <br />This document includes: <br />•A notification form to be used to notify the San Joaquin County Environmental Health Department Certified <br />Unified Program Agency {CUPA) of the closure of operations that generate hazardous waste. <br />•A closure work plan template is provided in Appendix A that may be used by generators. <br />Closure Requirements Authorities: <br />•See Appendix B for specific regulations citing the authority of the CUPA to require closure notification and <br />documentation. <br />Section A-Closure Date <br />A complete facility closure notification must be submitted to the CUPA 30 days prior to the beginning of closure activities. <br />The CUPA may still require a closure inspection. <br />Notification Submittal Date: _____________________________ _ <br />Proposed Date of Closure:. ______________________________ _ <br />Section B-Faclll� Information <br />Does this facility have an accurate and updated CERS submittal? □ Yes □ No <br />•If "YES", continue to Section C. If "NO" fill out the rest of Section B, create a CERS account, then continue on to <br />Section C. <br />1.Facility Information: <br />Facility Name :---------------------------------­ <br />Physical Address:--------------------------------- <br />City: ____________ State: _____ Zip Code: ______________ _ <br />County: ____________________________________ <br />2.Owner/Operator Information: <br />Name: ___________________ Phone Number: ____________ <br />Mailing Address: _________________________________ _ <br />City: ____________ State: _____ Zip Code: ______________ _ <br />3.Facility/Closure Contact Information: <br />Name: ___________________ Phone Number: ____________ _ <br />24-Hour Phone number: __________ Email: _________________ _ <br />SALLY BEAUTY SUPPLY #10229 <br />10710 TRINITY PKWY #C <br />Stockton CA 95219 <br />SAN JOAQUIN <br />Debbie Middleton (940) 297-4964 <br />SALLY HOLDINGS LLC <br />3001 COLORADO BLVD <br />DENTON TX 76210 <br />(940) 898-7500 <br />DMiddleton@Sallybeauty.com(940) 315.6782