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rag, c EPA l.: .` UMBER C'�71 971i_ 1 - III. RADIOACTWE MATERIALS OP WASTE Yes NO ❑ ❑ Does the facility use. store or treat to itoncdve materials or radioactive waste? IV. TYPE OF COMPAi+Y: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: Use either one or Mw SIC matt (a four wgit numoer) that best aesrtbe your company s proaucu. seri or uhausmai aaolr Euimpir-. aW Phzedakk to lab BW 1iduqna1 data' s First: 7384 Photofinishing Lab Second V. PRIOR PERMIT STATUS: Check yes or no to each question: YES NO [3 [31. Did you file a PBR Notice of Intent to Operate (DISC Form 8462) in 1992 for this location? ❑ ❑ 2. Do you now have or have you ever held a state or federal hazardous waste facility full permit or imer status for any of these treatment units? ❑ ❑ 3. Do you now have or have you ever held a state or federal full permit or interim starts for an!r oc harardous waste activities at this location? L ❑ 4. Have you ever held a vhuiaace issued by the Department of Toxic Substances Control for the treatmcm I am now notifying for at this location? ❑ ❑ 5. Has this location ever been inspected by the state or any local agency as a hazardous wave generator. VI. PRIOR ENFORCEMENT HISTORY: Not required frwn generators only mmf*g as cetadidomwtly ®'-F- or a owamerdal laundry. YES NO ❑ ❑ Within the last three years, has this facility been the subject of any convictions. Judgments, senlemenm e: r orders resulting from in action by any local, state. or federal environmental, hazardous waste. or public ter enforcement agency? (For the purposes of this form. a notice of violation does not constitute an order and need not be reported in it was not corrected and became a final order.) ❑ If you answered Yes, check this box and attach a listing of convieiions. judgments- settlements. or orders at copy of the cover sheet front each document. (See the Instsuctions for more infors .on) VII. ATTACF[lM TS: Attaehmous ar .x required for Commercial Laun ry fadliti m. 1. A plot plan/map detailing the iocation(s) of the covered unit(s) in relation to the facia.- boundaries' 2. A trait specific notification form for each unit to be covered at this location. P: DISC 1772 (1195)