Laserfiche WebLink
MAILING ADDRESS. IF DTFFA—`7: <br /> COMPANY NAME (DBA) Ifq—u -&w ��Ijjaiywy," <br /> STREET (3m ;(Q 4(ll�mrni✓�Fd�nu¢� <br /> U <br /> crrY "Al 121�I1^!IL STATE PI� zzP 1012 <br /> COUNTRY <br /> (may coognm if tut USA) <br /> CONTACT PERSON MILOW tr1ZZD PHONE NUMBER(�5 1 2: - 92' t <br /> (Fitts Hamel (Last Name) <br /> In. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC coder (a four digit number) that best describe your company's products, services, or industrial aaiviry. <br /> Eramole: 7384 Phatofinishine lab 3677 Printed circuit boards <br /> First: �5E)i Second: <br /> IV. PRIOR PERMIT STATUS: Cheek yes or no to each question: <br /> YES NO <br /> ❑ ff 1. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? <br /> ❑ 13� 2. Do you now have or have you ever held a state or federal hazardous waste facility null 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 /> ❑ 3. Have you ever held a vanance issued by the Department of Toxic Substances Control for the treatment you <br /> �-{ are now notifying for it this location? <br /> 0 ❑ 5. Has this location ever been inspected by the state x any local agency as a hazardous waste generator? <br /> V. PRIOR ENFORCEhIENT HISTORY: Not required from gertomars only notifying as m»ditiartally erernat. <br /> YES NO <br /> ❑ ❑ 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 /> ❑ 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 />