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March 8, <br /> 1996 11CJ �;u rtuce��iug riCWl)liVu IY/�411G�,1efGemv '0`Ld` <br /> NOTIFICATION OF XE ti <br /> ION fg\k?, 9g6 <br /> AS FOOD PROCESSING NEUTRALIZATION <br /> 10COMPANY EPA ID NUMBER: CA GA S 15 7 3'J 15 <br /> R <br /> COMPANY NAME (DBA): <br /> COMPANY MAILING ADDRESS: N. O. 4 X 5 7 <br /> CITY: 71ZAC y CA ZIP CODE 9S3? 8- o Q s 7 <br /> UNiT NAME: Wct�-t c tVtx f'ip- uNIT IDNUMBER: <br /> UNIT NAME: UNIT ID NUMBER: <br /> (for more units, add a separate page) <br /> Is your company eligible for the exemption noted on page 1? YES ✓ NO <br /> Are you authorized for any other treatment activity? YES_ NO ✓ <br /> If yes, under which tier are your other units authorized? <br /> CESW CESQT_ CA PBR_ <br /> STANDARDIZED PERMIT FULL PERMIT <br /> I certify under penalty of law that this document was prepared under my direction or supervision and the <br /> information is, to the best of my knowledge and belief, true, accurate, and complete. <br /> ,TESsE 8GCtFRXA ),qF&ry Supc.lvtSd /t <br /> Name (Print or Type) Title <br /> t % I/ MilRCbJ 99 <br /> tgnature Date Signed <br /> You must submit two copies of this completed page by certified mail, return receipt requested, to: <br /> Department of Toxic Substances Control <br /> Program Data Management Section - HQ 10 <br /> Attn: "Food Exemption Notification" <br /> 400 P Street, 4th Floor, Room 4453 (walk in only) <br /> P.O. Box 806 <br /> Sacramento, CA 95812-0806. <br /> You must also submit one copy of this page to your local regulatory agency. <br />