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EPA ID NUMBER r Ar-,Oo ;9 Page 2 of? <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME (DBA) 4Qr6S,r2acc -5 -ur-A'/oc CO, <br /> STREET PO Box 6189 <br /> or�q <br /> Com' Stn-ki-nn STATE C.A ZIP 95206 - <br /> COUNTRY <br /> (only complete if not USA) <br /> Ge xtol Os f lu- 3x1 <br /> CONTACT PERSON 1,Gn Xitagawa PHONE NUMBER 2( 09 ) 983 - -1-3-3-9- <br /> (First Name) (Last Name) <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a jour digit number) that best describe your company's products, services, or industrial activity. <br /> Example: 7384 Photofinishing lab 3672 Printed circuit boards <br /> First: 3728 Aircraft parts, n.e.c. Second: 3769 Space vehicle parts, n.e.c. <br /> IV, PRIOR PERMIT STATUS: Check yes or no to each question: <br /> YES NO <br /> ❑ ❑ 1. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? <br /> ❑ ❑X 2. Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim <br /> status for any of these treatment units? <br /> ❑ ® 3. Do you now have or have you ever held a state or federal full permit or interim status for any other <br /> hazardous waste activities at this location? <br /> ❑ ❑ 4. Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you <br /> are now notifying for at this location? <br /> ❑ ❑ 5. Has this location ever been inspected by the state or any local agency as a hazardous waste generator? <br /> V. PRIOR ENFORCEN ENT HISTORY: Not required from gcnerator.T only notifying ar conditionally eumpt. <br /> YES NO <br /> 0 ❑ Within the last three years, has this facility been the subject of any convictions,judgments, settlements, or final <br /> orders resulting from an action by any local, state, or federal environmental, hazardous waste, or public health <br /> enforcement agency? <br /> (For the purposes of this form, a notice of violation does not constitute an order and need not be reported unless <br /> it was not corrected and became a final order.) <br /> MV <br /> Uli If you answered Yes, check this box and attach a listing of convictions,judgments, settlements, or orders and a copy <br /> of the cover sheet from each document. (See the Instructions for more information) <br /> DTSC 1772 (1/93) Page 2 <br />