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State of California - California Environmervs)rotection Agency `� Department of Toxic Substances Control <br /> Check Number Page 1 of 7 <br /> ONSITE HAZARDOUS WASTE 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 /> Please refer to the attached Instructions before completing this form. You may notify for more than one permitting tier by using this <br /> notification form,DTSC 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 (TTU'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 notification 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 TIER not per UNIT. For example,if you operate 5 units but they are all Conditionally Authorized,you <br /> only owe$1,140,NOT 5 times$1,140. If you operate any Permit by Rule units and any units under Conditional Authorization you <br /> owe$2,280.) Checks should be made payable to the Department of Toxic Substances Control and be stapled to the top of this form. <br /> 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 notification forms you must attach. <br /> Conditionally Exempt 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 /> (ent per unit) <br /> A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) $ 100 <br /> C. 1 Conditionally Authorized (Form DTSC 1772C) $ 1,140 <br /> D. Permit by Rule (Form DTSC 1772D) $1,140 <br /> I Total Number of Units Total Fee Attached$ 1140 <br /> 11. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CAD 9 3 2 0 4 3 0 1 0 BOE NUMBER(if available)H_HQ________ <br /> NAME(Company or Facility) Chiron Corporation <br /> (DBA--Doing Business As) <br /> PHYSICAL LOCATION 14393 S. Airport Way <br /> For DISC Use Only <br /> CITY Manteca CA ZIP 95336 Region <br /> COUNTY San Joaquin <br /> CONTACT PERSON Elliott Eaton PHONE NUMBER(510)420-3398 <br /> (First Name) (Last Name) <br /> DTSC 1772 (1/'93) Page I <br />