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State or CWiforoja.Catitornia Easirooment- sroteetioa A; t j neportmat of Tock Sutntaaces Caotd �1�1 ISIS amu 1 sJ' i", Page. I of APR p 1 1993 ENVIRONMENTAL HEALTH ON5TTE HAZARDOUS WA5£EI',. Tl! ENT NO')��•�r1"�� )FORM FACILITY SPECIFIC NOTIFICA'�It9�I�' ''`�� !.' 4LT;1 x For Use by Hazardous Waste Generators Perforuun�tl+eaf�ea(„ Initial Under Conditional Exemption and Conditional Authorization, ❑ Revised � and by Permit By Rule Facilities a r� Please refer to the attached instructions before completing this form. You may notifyformrm than onepermirting tier by using this notification form, DTSC 1772. You must attach a separate unit specific not(cation form for each unit at this location. There are different unit specific nortftcationforms for each of thefour categories and an additional not fcationform for transportable treatment units (77T1's). You only have to submit forts for the tier(a) that cover your unit(s). Distend or recycie the other un sedor . Number each page of your completed notification package and indicate the total number of pages at the top of each pagem 'Page _ of_% Put your EPA ID Number on each page. Please provide all of the information requested; all fields must be completed except those that state 'if different' or 'if available'. Please We the information provided on this form and any attachments. The notification will not be considered complete without payment of the appropriate fee for each tier under which you are operating. (Please note that the fee is per TIER not per UNIT. For example. if you operate 5 units but they are all ConditiwtalOAutharized, you only owe$1.140, No75 times$1,140. If you operate any Permit by Rule!nits and any units under Conditional Authorization you owe$2,280.) Mucks should be made payable to the Department of Toxic Substances Control and be stapled to the top of this form. Please write your EPA ID Number on the check Fill in the check number in the box above. I. NOTIFICATION CATEGORIES Indicate the number of units you operate in each tier. This will alto be the number of unit specific notification forms you must attach. Caedituma7ly Emir"Small Quantity 7hmonent operations may rot operate exalts under any other tie: Number of units and attached unit specific notifications Fee per Tier (nor per rmlq A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 B. 1 Conditionally Exempt-Specified Wastestneatn (Form DTSC 1772B) $ 100 C. Conditionally Authorized (Form DTSC 17720) $1,140 D. Permit by Rule (Form DTSC 1772D) $1,140 1 Total Number of Units Total Fee Attached $ 100.00 U. GENERATOR IDENTIFICATION EPA ID NUMBER CA 0 0 0 0 0 6 6 9 5 7 BOE NUMBER (if available) H AHQ 3 6 1 0 2 0 9 5 NAME (Company or Facility) Heinz, U.S.A. (DSA—Doing Rugine.As) PHYSICAL LOCATION 2800 South Qalifornia Street CIT1, Stockton CA ZIP 95206 FM SC Use only Region COUNTY CONTACT PERSON Kurt Brause ' PHONE NUMBS 2R�09.) 948 --2782 . ..(Fire Name) ([its Name) DTSC 1772 (1/93) Page 1 6/6'd ZHI3H'f-H ZS:80 E6, 06 8UW