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EPA ID NUMBER rnr nnn1n 50 <br /> Page 2 of 6 <br /> �• -RADIOACTIVE MATERIALS OR WASTE <br /> YES NO <br /> Does the facility use, store or treat radioactive taatenals or radioactive waste? <br /> IV. TYPE OF COMPANY: STANDARD MUSTRIAI, CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a four digit number) that bat describe Your companv's products, services. or industrial aca irv. <br /> Example' 7384 Photofinishing lab <br /> 7178 /ndastrfallaundercrs <br /> First: Sql J FF.TATi HATN DR 1l' $e(•p : <br /> STORE <br /> V. PRIOR PERMIT STATUS: Check yes or no to each question: <br /> YES NO <br /> 12 1. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? <br /> _ 7 2. Do ,you now have or have you ever held a state or federal <br /> hazardous waste facility full permit or interim <br /> status for any of thea treatment uniu? <br /> ❑ 3. Do you now have or have you ever held a state or federal full permit or interim status for any other <br /> hazardous waste activities at this location? <br /> ❑ 4 Have you ever held a variance issued by the Department of Toxic Substances Control for the ttnmrmt you <br /> are now notifying for at this location? <br /> ❑ 5- Has this location ever been inspected by the state or any local agency as a hazardous waste generator? <br /> VI. PRIOR ENFORCEMENT HISTORY: Not required from conditionally exempt generators or commercial laundries. <br /> YES NO <br /> Within the last three years. has this facility been the subject of anv convictions, judgments, settlements• or final <br /> orders resulting from an action by anv local, state, or federal environmental, hazardous waste. or public health <br /> enforcement agency? <br /> (For the purposes of this form• a nonce of violation does not constitute an order and need not be reported unless <br /> it was not corrected and became a final order.) <br /> If you answered Yes, check this box and attach a listing of convictions,judgments, settlements, or orders and a copy <br /> of the cover sheet from each document. (See the lnstruc[tons for more information) <br /> VII. ATTACIA"T-NTS: Attachments are not required from commercial laundries, <br /> X A plot plan/map detailing the location(s) of the covered umt(s) in relation to the facility boundaries. <br /> x - A unit specific notification form for each unit to be covered at this location. <br /> DTSC ;772 (G96) <br /> Page 2 <br />