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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 18$8 EAST HAZELTON AVENUE, STOCKTON, CA 95205 <br /> (209)488-3420 FAX (209) 488-0138 <br /> UNIVERSAL WASTE AEROSOL CAN PROCESSING NOTIFICATION <br /> This notification shall bo submitted In person or by certified mail,with return recelpt requested <br /> I. FACILITY INFORMATION <br /> CILITY NAME: EPA ID fVUMBER:2-1 Zo,'nn <br /> l.fc Le <br /> LOCAT NlMAILING ADDRESS FA ILt PHONE NO <br /> LQ c n � <br /> ZIP CODE, <br /> ACILI CONTA THAM <br /> rF • f V O <br /> � � CONT"l�' � ONE NO: <br /> `l <br /> II. PROCESS DESCRIPTION <br /> TYP . -� n D�ak, <br /> E F AE�OSOL CANS <br /> ESTIMATED,XOLUMES OR QUANTITIES TO BE PROCESSED MONTHLY; <br /> 61 <br /> "EQUIP <br /> ENT PROCESS ORP OC SS S DESCRIPTION' <br /> �f �S p rh , his fi ItAckal , �,rrnal'n,rig ma 'c� <br /> NT ESCRiPTION <br /> Ori Vo c.. <br /> EQUIPMENT DESIGN CAPACITIESISM <br /> III. 47�ARDOUS WASTE TREATMENT RESIDUALS <br /> DESCRIPT19N OF THE CHARACTERISTICSHAZARDOUS TREATMENT RESIDUALS <br /> L:\gwo ma-, Cry a.k pT5-8 3 Flash poinf >33" <br /> DESCRIPTION I F MANAGEM NT OF ANY HAL4Rpt7U TR ENT RESIDUALS <br /> Crap r l� r do -[hw 1$o d U cep herd <br /> IV, CERTIFI ATION <br /> I cerlity under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system <br /> designed to assure that qualified personnel properly gather and evaluate the information submitted Based an my inquiry of the person or persons who <br /> manage the system,or those persons directly responsible for gathering the information,the btformation submitted Is,to be the best of my knowledge and <br /> belief,true, accurate,and complete I am aware that there are significant penalties for submitting false information Including the possibility of fine and <br /> im rlsonment for viol tions <br /> SIG RE' / DATE° <br /> Iwa d. <br /> NAME s3F PERSON�S�GNING C #TIFICATION( INT) T� LE; <br /> 'Hata:Far the CA Cada egulatlans,Titto 22,section 66270.14,thio natiffcetian must be signed as follows: IF <br /> • For a corporation by a responsible corporate officer,e g president, secretary treasurer,or vice-president of the corporation In charge of a principal <br /> business function.or any other person oulhofted to perform similar policy or decision-making functions,which govern the operation of the regulated <br /> facility,for the corporation <br /> - For a partnership or sale proprietorship by a general partner or the proprietor.respectively <br /> For a municipality, Slate, Federal or other pubfic agency by efther a principal executive officer or ranking elected official For purposes of this <br /> sedlon, a principal executive officer of a Federal agency includes the chief executive officer of the agency or a senior executive officer having <br /> resi3onsibility for the overall eralfons of a p dncipaf rd hic unit of thea11:1 anr v e q,R fonal Administrators of USEPA <br />