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EPA M : `..fBER CAL000126635_.� Page 2 of 6 <br /> M. RADIOACTIVE hIATERIALS OR WASTE <br /> YES NO <br /> ❑ © Does the facility use, store or treat radioactive materials or radioactive waste? <br /> IV. TYPE OF COMPANY' 'zTANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or rev SIC codes t,_ our digit number) that test describe your company's products, services, a -ndusmal activity. <br /> E.xampie: ZM Photofinishing lab 2M htdustrial fmodervs <br /> First: 7384 Photofinishin7 Lac Second: <br /> V. PRIOR PERMIT STATUS: Check yes or no to each question: <br /> YES NO <br /> ❑ ❑ 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 /> am now notifying for at this location? <br /> ❑ ❑ 5. Has this location ever been inspected by the state or any local agency as a hantdous waste generator? <br /> VI. PRIOR ENFORCEMENT IIISTORY: Na required front gcrctaars only naafying as rnwdtriOMUy Qawpt or @° <br /> cm mercud Laundry. <br /> YES NO <br /> ❑ ❑ Within the last throe years, has this faciliri x the subject of any convictions, judgments. settlements, or frau <br /> orders resulting from an action by any local, state. or federal environmental. hazardous waste, or public heald <br /> enforcement agency? <br /> (Fix the purposes of this form, a notice of violation does not constitute an order and need not be reported unles <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 <br /> copy of the cover sheet from each document. (See the Instructions for more information) <br /> VII. ATTACHMENTS: Auadunori are tsar mquurd for Cwhunmdal laundry faciatia- <br /> 1. A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries. <br /> 2. A unit specific notification form for each unit to be covered at this location. <br /> DTSC 1772 (1195) Page <br />