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} EPA ID NUMBER CAL000043115 page 2 of 3 <br /> ALAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME (DBA) Delta 'Radiology Medical Group, Inc. <br /> STREET' 1121 W. Vine St. Suite 15 <br /> CITY rrvli STATE ca"'ZIP 95240 <br /> COUNTRY <br /> (Orly complete if rant USA) _ <br /> CONTACT PERSON Nita KenT) PHONE NUMBER( 209) 369 -8261 <br /> (Fits Name) (Lau Name) <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a jour digit number) that best describe your company's products, services, or industrial acrivin•. <br /> Example: 73&4 Photofinishing lab 3672 Printed circuit boards <br /> ' First: gnil _RaAinl cKn, c)ffiro SNond: <br /> IV. PRIOR PERNUT STATUS: Check yes or no to each question: <br /> ITS 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 /> L p 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 /> ❑ ® 5. Has this location ever been inspected by the state or any local agency as a hazardous waste generator? <br /> V. PRIOR ENFORCEhM T HISTORY: Not required from generators only noting ar conditionally ezempc <br /> ❑ ❑ Within the last throe years• has this facility been the subject of any convictions,judgments, settlements, or foul <br /> orders resulting from an action by any local, state, or federal coviroamental, hazardous waste, or public health <br /> eu(WZ4 eat agency? <br /> (For the purposes of this form, a notice of violation does not constitute an order and need not be «porta) 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 cof <br /> of the cover sheet from each document. (See the Instructions for more information) <br />