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SAN J O A Q U I N Environmental Health Department <br /> OU NTY— <br /> UNIVERSAL WASTE AEROSOL CAN PROCESSING NOTIFICATION <br /> I. FACILITY INFORMATION <br /> FACILITY NAME: EPA ID NUMBER: <br /> City of Lodi Electric Utility CAD 981970825 <br /> LOCATION/MAILING ADDRESS: FACILITY PHONE NO: <br /> 1331 S. Ham Ln <br /> CITY: ZIP CODE: <br /> City of Lodi Electric Utility 95242 <br /> FACILITY CONTACT NAME: CONTACT PHONE NO: <br /> II. PROCESS DESCRIPTION <br /> TYPE OF AEROSOL CANS: <br /> 12 oz. - 19 oz. steel aerosol cans <br /> ESTIMATED VOLUMES OR QUANTITIES TO BE PROCESSED MONTHLY: <br /> 30 per month <br /> TREATMENT PROCESS OR PROCESSES DESCRIPTION: <br /> Puncture can, capture aerosol gases and any remiaining residual <br /> EQUIPMENT DESCRIPTION: <br /> Aerosolve Model 7000 can Recycling System with Activated Charcoal Filter <br /> EQUIPMENT DESIGN CAPACITIES: <br /> Replace pin and gasket every 4500 cans, Replace activated Charcoal fileter every 750 cans <br /> _ III. HAZARDOUS WASTE TREATMENT RESIDUALS <br /> DESCRIPTION OF THE CHARACTERISTICS OF HAZARDOUS TREATMENT RESIDUALS: Rainbow 85500-eye Irritant 213, <br /> Rainbow 87000-Acute Toxicity 4, carcinogencity 1 B, Aspiration Hazard 1 <br /> DESCRIPTION OF MANAGEMENT OF ANY HAZARDOUS TREATMENT RESIDUALS: <br /> Spent activated charcoal cannister and residual remaining will be disposed of as hazardous waste <br /> IV. CERTIFICATION <br /> I certify 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 on my inquiry of the person or persons <br /> who manage the system,or those persons directly responsible for gathering the information,the information submitted is, to be the best of my <br /> knowledge and belief,true,accurate,and complete. I am aware that there are significant penalties for submitting false information,including the <br /> possbilty of fine and imprisonmeriVor knowing violations. <br /> S]GNATURE'' DATE: <br /> - � //-/y-Zr) <br /> NAME OF PERSON SIGNING CERTIFICATION(PRINT) TITLE: <br /> 1 02 <br /> �'� ISS /`-1eGTri�SvPor�n�ev� <br /> 'Note: Per the CA Code of Regulations,Title 22,section 66270.11,this notIflcation must be signed as follows: <br /> • For a corporation: by a responsible corporate officer, e.g. president,secretary,treasurer, or vice-president of the corporation in charge of a <br /> principal business function,or any other person authorized to perform similar policy or decision-making functions,which govern the operation <br /> of the regulated facility,for the corporation. <br /> • For a partnership or sole proprietorship:by a general partner or the proprietor,respectively <br /> • For a municipality,State,Federal,or other public agency:by either a principal executive officer or ranking elected official, For purposes of this <br /> section,a principal executive officer of a Federal agency includes:the chief executive officer of the agency,or a senior executive officer having <br /> responsibflltV for the overall operations of a rinci al eo ra hic unit of thea enc e. .,Regional Administrators of USEPA, <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjgov.org/ehd <br />