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a&rnis CaUmmin- F.ovrdnme0 vtectloo Asaocr lkpuhtmset d TO*Su{>yvotet Coatid <br /> ... Page I of <br /> grate of C <br /> Cht u r 1- 1 <br /> aesa9C, 0 0 � <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> 'c For Use by Hazardous Waste Generators Performing Treatment Initial <br /> Under Conditional Exemption and Conditional Authorization. ❑ Revised <br /> a <br /> and by Permit By Rule Facilities <br /> a <br /> ry Please refer to the attached Instructions before completing chis form. You may notify far mon than one permitting tier by using this <br /> notification form,DISC 1772. You most attach a separate unit spedfic notifhcarion form for each unit at this location. There are <br /> different unit specific nor fcationforms for each of thefour categories and an additional notifrcationform far transportable treatment <br /> units (7T U's). You only have to submit forms for the tiers) that cover your unit(s). Discord 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_'. Put your EPA ID Number on each page. Please provide all of the information requested: all fseldt must be <br /> completed except those that state 'if dferent' or 'if available'. Please type the information provided on this farm and any <br /> attachments. <br /> The notification will not be considered complete without payrneat of the appropriate fee for each tier under which you are operating. <br /> (Please note that the fee is per TIER not per UNIT. For example, if you operate S units but they are all Conditionally Authorized, <br /> you only owe$1,140, XOT S times$1,140. If you operate any Permit by Rule units and any units under Conditional Authorization <br /> you owe$2,280.) Checks should be made payable to the Dgkv't trent of Tactic Substances Control and be stapled to the top of this <br /> form. Please write your EPA ID Number on the check Fill in the check number in the bas abate. <br /> L NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit spedfle tur0flearionforms you must attach. <br /> Conditionally h'rentpt 5rnall$tamwy Treatment operations may nag operate anw under airy other am <br /> Number of units and attached unit specific notifications Fee per Tier <br /> _ (nor Per wn) <br /> A. Conditionally Exempt-Small Quantity_Tseafinent (Form DTSC 1772A) $ 100 <br /> B. 1 Conditionally Exempt-specified Wastestmat (Form DTSC 177ZB) $ 100 <br /> C. Conditionally Authorial (Form DTSC 17724) $1,140 <br /> � MAR3119� <br /> D. _ Permit by Rule (Form DTSC 1772D) $1,140 <br /> ____ Cp'1��Ho51t h6orviws �9e==—���a <br /> C ` <br /> 1 Total Number of Units sA C R AM ENj Total Fee Attached $ 100.00 <br /> if. 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 /> (DBA—Doing Dmeess As) <br /> PHYSICAL LOCATION 757 East Eleventh Street <br /> For DT Use Onty <br /> CITY Tracy CA ZIP 95376 1 <br /> Region —�' <br /> COUNTY San Joaquin <br /> CONTACT PERSON Monroe Cosme PHONE NUMBER( 209 ) 832 _ 4282 <br /> ...(Oust Hem) (hast Nemo) <br /> DISC 1772(1/93) <br /> Page 1 <br /> 6iE'd ZHI3H'f-H 9T :60 E6. 0E allW <br />