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State of California-Califorvia Favimnmental Protection Agency Department of To3oe Substances Coutrw <br /> Chect Numbe: Page 1 of 25 <br /> 18029730 <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> "�. For Use by Hazardous Waste Generators Performing Treatment E3 Initial <br /> Under Conditional Exemption and Conditional Authorization, 1 Revised <br /> ti and by Permit By Rule Facilities <br /> Please refer to the attached Instructions before completing this form. You may notify for more than one permitting tier by using this <br /> notocarion form, DISC 1772. You must attach a separate unit specific notification form for each unit at this location. There are <br /> different unit specific notification forms for each of the four categories and an additional notification form for transportable treatment <br /> units (77U'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 notfcation 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 fields must be <br /> completed except those that state 'if different' or 'if available'. Please type the information provided on this form and any <br /> attachments. <br /> The notification will not be considered complete without payment of the appropriate fee for each tier under which you are operating. <br /> (Please note that the fee is per 77ER not per UNIT. For example, if you operate S units but they are all Conditionally Authorized, <br /> you only owe$1,140, NOT times$1,140. If you operate any Permit by Rule units and any units under Conditional Authorization <br /> you owe$2,2k) Checks should be made payable to the Department of Toxic 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 box above. <br /> I. NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit specific noticationforms you must attach. <br /> Conditionally Ekmgm Small Quantity Treatment operations may not operate units under any other tier. <br /> Number- of units and attached unit specific notifications Fee per Tier <br /> (not per unit) <br /> A. o Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. -,6 ,5- Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) $ 100 <br /> C. 1 Conditionally Authorized (Form DTSC 1772C) $1,140 <br /> D. 0 Permit by Rule (Form DTSC 1772D) $1,140 <br /> -T (. Total Number of Units Total Fee Attached S 1,240 <br /> H. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CAU 0 0 9 1 8 9 0 6 9 BOE NUMBER (if available) H A HQ3 LQ £7 7 <br /> NAME (Company or Facility) A-ppl;tQ Ae-ros12ace_ 675-,wc_4urts <br /> (DEA—Doing Business As) <br /> PHYSICAL LOCATION 3437 S. Ai rPnrt- Wav <br /> For DTSC Uce Only <br /> CITY Stockton CA ZIP 95206 - �8 <br /> Region <br /> COUNTY San Joaquin <br /> GcMICI 0s4ra,tde_r 3zl(c, <br /> CONTACT PERSON men + PHONE NUMBER( 209 ) aq� _- a3:3:9(Fret Nanw) (List Nana) <br /> DTSC 1772 (1/93) Page I <br />