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State of California-California Faviroumental Protection Agency Deparbnent of Toxic Substances Control <br /> TRANSPORTABLE TREATMENT UNIT PERMIT BY RULE <br /> SITE-SPECIFIC NOTIFICATION <br /> For Use by Transportable Treatment Unit CrTU) <br /> Treating Hazardous Waste Under Permit By Rule Initial <br /> (Pursuant to Title 22, California Code of Regulations, Chapter 45) <br /> Amended <br /> ❑ <br /> Extension <br /> 77tis form is to be used by all Permit-by-Rule (PBR) Transportable Treatment Units r=s) only. This Transportable <br /> Treatment Unit Permit-By-Rule, Site-Speck Nothcation supersedes DTSC Form 8429A. Ashen submitting an amended <br /> notification,put an asterisk next to the amended information. Please check the extension box only if you are requesting <br /> authorization for work beyond the one year time limit. The wastestreamr treated must be limited to those listed in Title 22, CCR, <br /> section 67450.11, which are also listed on this form. <br /> I. GENERAL TTU INFORMATION <br /> COMPANY EPA ID NUMBER CA O 2 2 <br /> BOE NUMBER (if available) H_HQ___may_____ = SERIAL NUMBER <br /> COMPANY NAME (DBA-Doing Business As) <br /> PHYSICAI: LOCATION _ZPT/ WEST at-M IVE- L A0,0 <br /> CITY ZE-NT(1—T: CA ZIP <br /> COUNTY LA KA(g <br /> COMPANY MAILING ADDRESS, IF DIFFERENT: <br /> STREET <br /> CITY STATE _ ZIP <br /> OWNER 'I N yX =N h STA-TAL 5EAyTGt,: 5 <br /> OWNER PHONE NUMBER <br /> ITU OPERATOR INFORMATION, ONLY IF DIFFERENT FROM OWNER <br /> OPERATOR NAME <br /> STREET <br /> CITY STATE ZIP <br /> OPERATOR.PHONE NUMBER (10.7) 71/j>- 37/ 1� <br /> TTU CONTACT' PERSON LZN0'68Y CAF MPEST F PHONE NUMBER (70'7)Z-�1[1l_ <br /> first name) (last name) <br /> • I <br /> DTSC Fom 1197(1/96) ;,_.. Page I <br /> m <br /> (Pviously DTSC 8429A)' <br />