Laserfiche WebLink
stme1 uwbrms•Caw—, s uhllemn Atm �rgsr��^w ■,..�.a s%.WN — <br /> Past 1 Of 22 <br /> 4P <br /> ,.,i YSOhlGr <br /> p,� <br /> ONSITE AZARDOUS WASTE TREATMENT NOTMCAT10N FORINT <br /> FAaM= SPEtjFIC NOTMCATION <br /> For Use by H+mdom Wasoe Gearralom Perfwming T ® Ini°w <br /> Under Caaditiocal Exemption aid Ceiba ud AudgwiMbon. ❑ Resed <br /> and by Permit By Rale Faailitiee <br /> Pum,c refer to Thee a: A=ruaians bdbre oarnples+tng dWforas- YOU+dy h0q&fOr MOM thaw~pemimixg tier by anng rhe <br /> t ntifhcatian form,,DISC M You mast attach a separate unit specific no"fldmatt(orae for eads unit ar flus ioauiox. Thar are <br /> different unit Veafic na :`-zsivx fvr=f;P retch ofdw four csotegaria and an addhiausl aanafu=i of Jor nwLP°t W rre&ftm <br /> starts (ITLP's). You oat-, -ave to submit fortes for the der(s) that cover yore'uatt{s). D&CO'd or rrtytk rhe Osrlser unused farrrht- <br /> Number ends pagr of ywrti ad naaniranon package and shsdneme rhe rota[chamber qfpages hu she rqv Of trach PnBr at thr <br /> •Page _ of Phar EPA ID Nwnber'on each page- Pkasr provide all of the requested:aft J lds rnaas be <br /> campleted cugx dom star r 'if diffmou' or 'if cvailable', pie= type tits iOarnhaaWn promAid ars this f om and any <br /> auddMa= <br /> The noriftwtion will n v ==W-red mwPI&C wuhvO PMJMM01the appropjaw fix for each tier under whic'1t you arc opera Ing. <br /> (Please nate drat the fee ner ITER not per UNIT per emrapk, if)'au opetme S unita bid they we all Conditionalty Awhwwwd, <br /> yva only ow$1.140. 6-: 5 tmrra SI.14Q ffyax operate any Permit by Rule woes and a1e1 whirr ursder Condhlonaj AmduNiurtion <br /> you owe 52.280.) Chew,.. uutld be made payable m rhe Department of Tush Substances CoMWW and be mapkd to the rap of rias <br /> fob's- Please,fill in die: +uumber in the b=abuw. <br /> L sx=cAn":° CA'1`EGOfRffS <br /> Wtcare the nwaber of r. you operate in arcs tier. 7h4 will also be the xmnber of unit speak aonficarjonfo+nss you Hour=ads <br /> C,areditiarhutty Fsrn+pr S- Qrtpadtj+hr�r+aa oprrmiae: q40uavcs u N&r arty Odw ria <br /> Number of refits and a:=,:e Beed unit specific hxitilrrcatioas Fee per Trrr <br /> (,ws per AM) <br /> A. 0 Cucj&4:-may Exsmgt-Small Qaw6ty Treatment (Farm DTSC 1772A) $ 100 <br /> B. b Condia= ly Exempt-Sp=fied Whstestrtatn (Form D'I'SC iTT2R) $ 100 <br /> C. 0 Conditz,---a11y Authorized (Form DTSC 17720) $1,140 <br /> p. 0 Few. -4 Rase (Form DTSC 1777.D) $1,140 <br /> b Totsa of Units Toll Fat Atmchod S 100 <br /> 11. GENERATOP.MEbnT KATION <br /> EPA ID NUMBER CA L 17 0 0 2 4 3 8 2 BOE NUMBER(if avaiiablc) H F HQ-3 E Q-10 4 3 2 <br /> NAME(COMPMY orFacilrtx) naval Communication Station Stacktan <br /> (DBA–Doing 81 A* <br /> PHYSICAL LOCATION Rough and Ready Island <br /> Use Oozy <br /> CITY Stockton CA ZIP 95203 - 5000 <br /> COUNTY San Joaquin <br /> CONTACT PERSON 6 ru ce James PHONE NUMBER2 0� 944 _ 0400 <br /> (Fere iNsms) 0.as NOW) <br /> { <br /> DTSC 1772 1193) ENCLOSUREN Pam 1 <br /> 90 'd 60V0 W He 'ON XH 7d.LNNVIAE Ofd 65: 10 CAM 96-H-11]0 <br />