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State of California California Integrated CIWMB 303a(7108) Waste Management Board Lead Agency Form CIWMB 303a Household Hazardous Waste Collection Information For FY 2008-2009 'A jurisdiction or agency which conducted and/or operated a permitted HHW program during the previous fiscal year. Section A.Reporting Requirements: Purpose of Forms CIWMB 303a and 3036 Eachjurisdictum in Callforwa is mandated to complete Form CfWbfe 303a or 3036 normally with the amount of household hazardous waste(HHW)collected and its method ofmanagemen (Cahfomia Cade of Regulations,Title 14,Section 18751.2). The Forms Cf%W 303E and 303b specifically fulfill the reporting requirements of the Household Hazardous Waste Element a the California Integrated Waste Management Homd's(CIWMB)Cmmtywide Integrated Waste Management Plans. The Forms CIWMB 303a and 303b are also regulated to satisfy the Department of Toxic Substances(DTSC)directive(Health and Safety Code Section 25218.10)to collaboratively maintain HHW volume totals with the CIWMB for all HHW eg0ectio events,facilities,and programs within the Stare. The completed Forms CIWMB 303a and 3035 provide the tool waste volume amounts collated for all HHW programs(including paramount,temporary,recycle only,mobile,door to door, and any other type of collection program the jurisdiction identifies as part of their HHW collection program)that were sponsored in the previous fiscal your,starting July 1 of the previous year and ending June 30 of the current year,as well as the management methods for a0 HHW collected. Who must fill out the Forma? Each jurisdiction must fill out a Fpnm CIWMB 303a or 303b. If yourjurisdiction or agency was the Lead(i.e.,conducted or operated a permitted HEW program)for co0ecting HHW,you will report your waste collection and management methods on the Lead Agency Form CRUMB 303a. If your jurisdiction or agency did not have a HHW collection Frogrem during the previous fiscal year,or was not the Lead for a permitted collation program,you will complete the Non-Lead Agency Form CRUMB 303b to satisfy the regulatory requremems. You ran download the complete Lead Agency or Non-Lead Agency forms at Imp://www.ciwmb ca.gov/hhw/reporting/default hon or contact DTSC at(916)323-3513 to have one sent to you. The completed Form CrWNM 303a or 303b must be sent to DTSC on or before October I of each year. Where do I send my completed Ferro? Completed fortis shall be submitted electronically to DTSC w an e-mad attachment to form303@bmeca.gov.You must fust save the completed spreadsheet on your own computer under new name. Use a name that will uniquely and clearly identify yourjuriadiction or agency such as SacmmentoForro303.rds,for example. Them,send the newly named completed spreadsheet in an a-mail attichmentto the address above. Upon request to CIWMB,you may be exempted from filing electronically,and instead print out the completed spreadsheet and mail it to: reminisced of Toxic Substances Control(DTSC) Household Hazardous Waste(HHW)Program-Form 303 P.O.Box 806 Sacramento,CA 958140806 Section B.Jurisdiction: For County-rum programs,please specify"unincorpormed"or"countywide" Name of Public Agency Reporting: San Joaquin County(countywide) 1)Escalw, 5)Ripon 9) Now-Lead Participants Represented by Reporting Jurisdiction/Agency(i.a, 2)Lathrop 6)Tracy 10) Individual city(io),eouisty(ins),other 3)Lodi 7)Stakmn 11) agency(io)): 4)Mention 8)Unincorporated Sam Joaquin County 12) Mailing Address: P.O.Box 1810 City; I Stockton Zip wide 95201 County: San Joaq.'. ®W Program Manager: Kimbm Andrews PlumeNumber: 209-468-3066 Fax Number: 209468-3078 Email Addreot kandrews@sjgov.org Contra bar's Name(if appl)wihde): Clean Harbors Environmental Services Naar ofPexmaawf Facllttywitbiv Program Swim Aro(ifapp0oble): Sao Jaoquin County HHW Facility EPA HIM: CAH111001044 Site Contact NamNritle: Terraria Wilbomn,Facility Supervisor(contracted staff) Phone Number: 209468-5670 Facility Addrma: 7850 RA Btdgefmd Sweet Email Address: milbo=@sjgov.org City: Stockton Zip Code: 95206 County: San Joaquin Name ofPc mavmt Fi cdity wiNia EPA IDM: Pr ce Area if• liable: Site Contact NamefFithu Phone Number: Facility Address: Email Address: City: I zip Code: County: Name of Permmust Facility withbu in EPA IDM: Pro nm Service Area if• iium Site Contact Namerride: Phone Number: Facility Address: Emag Addrest: City: tip Code: County: For addithmal permanent facilities within the program service aro,plicae eunuch a separate page Section C.Program Types: The program types include Permanent.Temp rnm,,(periodic),Mobile,Recycle-only program,Door-to-Dow(residential),Curbside,Load Check and/or Other(identify We of program). Remember-Certified Oil Centaur and Curbside Oil conation programs,whose oil Is reported as part of a jurisdiction's used oil Block Grant,should not be included in Form Section D.EPA ID Numbers: lase lin a0 EPA ID Numbers for each program type mind lastycar(add additional rows if necessary). Program Type EPA to Number Program Type EPA m Number Permanent CAH 111001044 Temporary CAH777001696 Section E.Participation: Number of Households 1W pardtlpatM V collection program: 6551 Number of Homebilds in service mea: 205,800 Section F.Waste Volumes: N tlm example dust below,fw dc,pedod July 1,2004 toJure 30,2005 occur the hissing"Ponds Collected by Pmgam T)We the Co,her su:rod then number ofpmmds of reason in do ams,strew "Flammable ti9olde/so5ds"rdlxmi zviMio dm Cary hn 0eu0 canmpooding m 5a moFw rypeused b collet em Eample: lad emmmtuedrm owbmo"fruwd Pounds Mcmolmd'm mThteradpPmanesdianhgecrest rrhilel mcdmcaWgaamk mthme uwgWaPoybuun.dhIsv foIbrisyoaux.amPPleleemucmh k.40 mpmbuedseatece.uthNewndrclhtvme u"dYmaurad 6 s PppDoovuuhnmnpddoses snCeomdoflttl hleDectiWeviedar"yWl i.csSo"tOhg,ewrpM oadwwCity W uumweveincmomd44Pow&walnwmCwt, -T. P.-to DrspoialZbvtcdum e Panelsconeewd by ProgrwnT w Ponds Dimamd I Disertee by Management Mellon Page 1 of 3