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D� ' ofq�� 1ZA <br />nee Control <br />state of California - Environmental Protection Agency <br />EDTSCREGIONAL <br />SE ONLY j. Q <br />Qj OFFICE <br />JIM,, <br />7 <br />TEMPORARY HOUSEHOLD HAZARDOUS WAST y STATE OF o <br />COLLECTION FACILITY O <br />CALiFG'I4j.4. <br />PERMIT BY RULE NOTIFICATION EPA <br />heCEI�l9 <br />For use by agencies operating a Temporary Household Hazardous Waste Collection Facility ('ITHHWCF) under y <br />Rule. Each <br />location requires a separate form. <br />REVISED NOTIFICATION Put an <br />INITIAL NOTIFICATION asterisk in the left margin next to the <br />P revised information. <br />I , GENERAL INFORMATION / <br />A. FACILITY ID NUMBER CAHI II000612 <br />B. FACILITY NAME Taft Community Center Parkin Lot <br />C , FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />ADDRESS 389 Down:Lng Avenue <br />CA ZIP CODE 95206 <br />CITY Stockton <br />COUNTY San Joaquin <br />D , OPERATOR (PUBLIC AGENCY) <br />AGENCY NAME County of San Joaquin Department of Public Works <br />MAILING ADDRESS P.O. Box 1810, 1810 East Hazelton 95201 - <br />CA ZIP CODE <br />CITY Stockton <br />COUNTY <br />E, OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />Alison <br />CONTACT PERSON Hudson(LAST NAME) (FIRST NAME) <br />PHONE NUMBER 209 468-3066 <br />Page 1 of 4 <br />DTDMW ORMS\PBR FORM <br />) <br />