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State of California.Cai/arty Eorvaerueatal Protection Agency Depai tmeaa of Toxic Subanoca Coettal <br /> =;] e Page I of Z <br /> 9 3 0 0 0 8 <br /> I <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> Z FACILITY SPECIFIC NOTIFICATION <br /> For Use by Hazardous Waste Generators Performing Treatment Pa Initial <br /> Under Conditional Exemption and Conditional Authorization, ❑ Revised <br /> and by Percrut By Rule Facilities <br /> y` Please refer to the attached Instructions before completing this form. You may notify for more than one permitting tier by using this <br /> I not fication form, DISC 1772. You must attach a separate unit speck not fication form for each unit at this location. There are <br /> different unit specific notication forms for each of the four categories and an additional notiftcationform for transportable treatment <br /> units (77i1's). You only have to submit forms for the tiers) 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 /> aaadrmeets. <br /> The notification will not be considered complete without payment of the appropriate fee for each tier undo which you are operating. <br /> (Please note that the fee is per TIER not per UNIT. For example, if you operate S units but they are all Conditionally Authorized, <br /> you only owe$1,140, NOT5 dma.$1,140. If you operate any Permit by Rule units and any units undo Conditional Authorization <br /> you owe$2,280.) 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 /> L 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 /> CondtionaUy Eaw" SmaU Qttandry 7humment operations may not operate units under any otter tier. <br /> Number of units and attached unit specific notifications Fee per Tier <br /> (nor per wit) <br /> A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. 1 Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) <br /> C. Conditionally Authorized (Form DTSC 1772C) $1,140 <br /> D. Permit by Rule (Form DTSC 1772D) $1,140 <br /> 1 Total Number Unit SEP 2 ; 1993 � Total Fee Attached $ 100.00 <br /> IL GENERATORIDENIICATIONTMENT <br /> p, pFTO-� l <br /> ......_._ ,ES CON <br /> EPA ID NUMBER CA D981577059 – TROL– BOE NUMBER (if available) Hy HQ 36011341_ <br /> NAME (Company or Facility) Tri Valley Growers <br /> (DBA—Dairy&a —As) <br /> PHYSICAL LOCATION Plant 4 <br /> 3200 East Eight Mile Road <br /> Far DISC Use Only <br /> CITY Stockton CA ZIP 95212 _ <br /> Region <br /> COUNTY San Joaquin <br /> CONTACT PERSON Jeff Wong PHONE NUMBER( 209 ) 931 _ 1531 <br /> (Fina Name) (tAa Nam) <br /> DTSC 1772(1/93) Page I <br />