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EPA ID NUMBER CAD 0 2 Q 5 0 4 7 4 3 Page 2 of 6 <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME (DBA) A. Teichert & Son, Inc. <br /> STREET Mobile Equipment Division <br /> P .O. Box 15002 <br /> CITY Sacramento STATE CA ZIP 95851 - <br /> COUNTRY <br /> (aNy complete if n USA) <br /> CONTACT PERSON George Takemori PHONE NUMBER 9( 16 )386 - 6916 <br /> (Fat Name) (Lsrt Name) <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a four digit number) that best describe your company's products, servicer, or industrial activity. <br /> Example: 7384 Photofinishing lab 3671 Printed circuit boards <br /> First: 1611 Hwy Street Const. Second: <br /> IV. PRIOR PERMIT STATUS: Check yes or no to each question: <br /> YES NO <br /> ❑ Q 1. Did you file a PBR Notice of Intent to Operate'(DTSC Form 8462) in 1992 for this location? <br /> ❑ ® 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 /> ❑ 0 5. Has this location ever been inspected by the state or any local agency as a hazardous waste generator? <br /> V. PRIOR ENFORCEMENT HISTORY: Not required from genermors only troti.&ng as conditiondly ewnpt. <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 aced 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 />