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Sew e/C&6&ru6• California X"ri sal Protarti"Agowey D"W"Wr of Sege Sabaneet Cootrd <br /> Check _ - Page 1 of <br /> APR 01 <br /> -190NMEVIL' ,L <br /> ONSITE HAZARDOUS WASTIS TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> For Use by Hazardous Waste Generators Performing Treatment ® Initial <br /> Under Conditional Exemption and Conditional Authorization. ❑ Revised <br /> and by Permit By Rule Facilities <br /> C <br /> a <br /> h Please refer to the attached Instructions before completing this font. You may ratify for more than one permirring rier by using this <br /> I notification form, DISC 1772. You must attach a separate unit specific notification form for each unit at this location. Then are <br /> different unit specific nor fcarionforms for each of rhe four categories and an additional norfficationform for transportable treatment <br /> units (ITV's). You only have to submit forms for the tier(s) that cover your unit(s). Discard or recycle the other unused forms. <br /> Number each page of your completed nor f cation package and indicate the total number of pages at the top of each page at the <br /> 'Page _ of_'. Pur your EPA ID Number on each page. Please provide all of the information requested,- all fields mast be <br /> completed ercept those that state 'if different' or 'lf available'. Please type the information provide( on this form and any <br /> attachments. <br /> The not f cation will not be considered complete without payment of the appropriate fee for each stir under which you are operating. <br /> (Please note that rhe fee G per ITER not per UNIT: For example, f you operate S units but they are all Conditionally Authorized, <br /> you only owe$1,140, NOT S diner$1,140. If you operate any Permit by Rule units and any urtica under Conditional Autho-i-ation <br /> you owe$2,280.) Cheats should be made payable to the Deparnnenr of Toxic Substances Control and be stapled to rhe to[ of this <br /> form. Please write your EPA ID Number on the disc*. Fill in the check number in the box above. <br /> L NOTIFICATION CATEGORIES <br /> Indicate the number of wits you operate in each tier. This will also be the number of unit spedJte nor fcarion forms you must arrach. <br /> Condltionally Exanp( Small Quantity Thcsmrreu operudons nary roe operwe anus under any other tier <br /> Number-of units and tLLtaehed unit specirie notifications Fee per Tier <br /> Ilwt per-N') <br /> A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. 1 Conditionally Exempt-Specified Wastestram (Form DTSC 1772B) $ 100 <br /> C. Conditionally Authorized (Form DTSC 17720 $1,140 <br /> D. Permit by Rule (Form DTSC 1772D) $1,140 <br /> 1 Total Number of Uaitc Total Fee Attached $ 100.00 <br /> n. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CA D 9 8 1 5 7 3 7 9 3 BOE NUMBER (if available) H_HQ-_,^__ __ _ <br /> NAME (Company or Facility) Heinz U. S.A. <br /> (DRA-Doing Buroess Aa) <br /> PHYSICAL LOCATION 757 East Eleventh Street <br /> It; 'rsc use ode <br /> CITY Tracy CA ZIP 95376 _ <br /> Region <br /> COUNTY San Joaquin <br /> CONTACT PERSON Monroe Cosme PHONE NUMBER 2( 09 ) 832 - 4282 <br /> (Fud Name) (Leta Name) <br /> DTSC 1772 (1193) Page I <br /> F•'1 'd ZH13H'f-H 9T :60 E6. 0E allW <br />