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EPA M NUMBER Page_ of_ <br /> PERMIT BY RULE <br /> JAN 181986 UNIT SPECIFIC NOTIFICATION <br /> For Fixed Treatment Units Only <br /> (pursuant to Title 22, California Code of Regulations, Chapter 45) <br /> SAN N 10A U.IN.COU' <br /> - <br /> OFFICE OFA <br /> V. UNrr OWNER INFORMATION, ONLY IF DIFFERENT FROM GENERATOR <br /> OWNER NAME <br /> STREET <br /> CITY STATE 7JP - COUNTRY <br /> (may coupku if USA) <br /> CONTACT PERSON PHONE NUMBER(_) <br /> (8mt Mine) Nd Mme) <br /> VI. ATTACHMENTS: <br /> ❑ A. A certification specifying the local agencies that have been notified of the operation. (Mandatory) <br /> 0 B. Documentation that the facility operator has notified the property owner of the operation of the unit. <br /> (Required only when the property owner is different from the generator/operator.) <br /> ❑ Check this box if the generator is also the property owner. <br /> C. A brief description of how the treatment unit operates (i.e., continuous, batch, intermittent, etc.). <br /> The manufacturer's operation specification sheet can be used to satisfy this requirement. (Mandatory) <br /> D. The tank and/or containment system certifications required by Title 22, CCR, Sections 66264.175(c)for containers <br /> and containment systems and 66265.191(a) and 66265.192(x) for tanks. (Mandatory, although the type of <br /> certification depends on the type of treatment unit, either tank or container.) <br /> ❑ E. Phase I Environmental Assessment Checklist (required after January 1, 1996) <br /> ❑ F. Financial Assurance Closure Documentation(required after January 1, 1995)and Liability Documentation (required <br /> by January 1, 1998). <br /> DTSC 1772D (1/95) Page 23 <br />