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COMPLIANCE INFO_PRE 2019
EnvironmentalHealth
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2231-2238 – Tiered Permitting Program
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PR0506911
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COMPLIANCE INFO_PRE 2019
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Last modified
8/31/2020 2:03:06 PM
Creation date
7/30/2020 7:43:45 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2231-2238 – Tiered Permitting Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0506911
PE
2234
FACILITY_ID
FA0007405
FACILITY_NAME
DELTA RADIOLOGY MED GROUP INC
STREET_NUMBER
541
STREET_NAME
HAM
STREET_TYPE
LN
City
LODI
Zip
95242
APN
03329009
CURRENT_STATUS
02
SITE_LOCATION
541 HAM LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
FilePath
\MIGRATIONS\Tiered Permitting\H\HAM\541\PR0506911\COMPLIANCE INFO.PDF
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EHD - Public
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EPA 1D NUMBER C1IL000IIb3IIS— _ <br /> Page 3 of_ <br /> i VI.' A7TACEDIENTS: <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 /> VII. CERTIFICATIONS: This form must be signed by an authorized corporate officer or any other person in the comparry who <br /> has operational control and performs decision-making functions that govern operation of the facility(per title 22, California <br /> Code oirRegulations (CCR)section 66270.11). All three copier must haw original signarurer., <br /> Waste'Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the <br /> degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or <br /> disposal currently available to me which minimizes the present and future threat to human health and the environment. <br /> Tiered Permitting Certification I certify that the unit or units described in these documents meet the eligibility and operating <br /> requirements of state statutes and regulations for the indicated permitting tier, including generator and seconday containment <br /> requirements. I understand that if any of the units operate under Permit by Rule or Conditional Authorization, I will also be required <br /> to provide required financial assurances by January 1, 1993, and conduct a Phase I environmental assessment by January 1, 1995. <br /> A certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance <br /> with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry <br /> of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to <br /> the best of my knowledge and belief, true, accurate, and complete. <br /> I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment <br /> for knowing violations. <br /> Business Manager <br /> "Name (Priv or T - Title <br /> Signa tare <br /> Date Signed <br /> "It <br /> OPERATING REQUIREMENTS: <br /> Please rote that generators treating hazardous waste onsite are required to comply with a number of operating requirements which <br /> d ffer depending on the tier(s) under which one operates. These operating requirements are set forth in the statutes and regulations, <br /> some of which are referenced in the Tier-Speck Factsheers. <br /> SUBMSSION PROCEDURES: <br /> You must submir two moles of this completed notification by terrified mail, return receip!,o quest ed, to: <br /> Department of Toric Substances Control <br /> Form 1772 <br /> Onsite Hazardous Waste Treatment Unit <br /> 400 P Street, 4rh Floor (walk in only) <br /> P.O. Boz 806 <br /> Sacramento. CA 95812- 0806. <br /> •u must also submit one mov of the notification and attachments to the focal regulatory agency in your jurisdiction as listed in the <br /> uimction mareriab. You must also retain a copy car part of your operating record. <br /> All three forms must have original signatures, not photocopies. <br /> DTSC 1772 (It93) p ,, <br />
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