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State of California -Environmental Protection Agency, Department of Toxic Substance Control <br />FOR OFFICIAL USE ONLY ORIGINAL <br />DTSC REGIONAL OFFICE <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />For use by agencies operating a Temporary Household Hazardous Waste Collection Facility (THHWCF) under Permit By Rule. Each <br />location requires a separate form. <br />X INITIAL NOTIFICATION REVISED NOTIFICATION Put an <br />asterisk in the left margin next to the <br />revised information. <br />I. GENERAL INFORMATION <br />111000527 <br />C. FACILITY ADDRESS OR LEGAL DESCRIPTION OF FACILITY <br />LOCATION <br />DRESS 2323 E Lovelace Road <br />I Manteca <br />CA ZIP CODE 95336 <br />COUNTY San Joaquin <br />D. OPERATOR (PUBLIC AGENCY) <br />AGENCY NAMEounty of San Joaquin Department of Public Works <br />AILING ADDRESS PO Box 1810, 1910 Hazelton <br />CIT Istockton CA ZIP CODE 95201 <br />COUNTY Isan Joaquin <br />E. OPERATOR/AGENCY CONTACT PERSON INFORMATION <br />CONTACT PERSON Hudson Alison <br />............. <br />_....__....._... <br />_.................... <br />. ----.._.._._...__._..... <br />__...---....._. <br />LAST NAME) FIRST NAME) <br />HONE NUMBER 209) 468-3066 <br />DTSC 8464 (9/92) Page o f 4 <br />FS/ADMINFORMS\PBR FORM <br />