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' State e(Cakforula.California Fnrir ental Pn�n Aseucy Department of Trade Sachsen Ca" <br /> r Page I of CL763f5G 9 2 00 0 1 4 <br /> I <br /> v ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> For Use by Hazardous Waste Generators Performing Treatment ❑ Initial <br /> V Under Conditional Exemption and Conditional Authorization, ® Revised <br /> and by Permit By Rule Facilities <br /> ti <br /> c j Please refer to the attached instructions before completing this form. You may notes for more than one permitting tier by using this <br /> not(cation form, DISC 1772. You must attach a separate unit specific not(cation form for each unit at this location. There are <br /> different unit specific not f cation forms for each of the jour categories and an additional notifraatfonform for transportable treatment <br /> units (T7'U's). You only have to submit forms for the tiers) that cover your unit(s). Discard or recycle the other unused fours. <br /> Number each page of your completed notification package and indicate the total number of pages at the top of each page at the <br /> Page _ of_'. Put your EPA ID Number on each page. Please provide all of the information requested,- all fieldr must be <br /> completed except those that state 'if different' or 'if available'. Please type the information provided on this form and any <br /> attachments. <br /> The notification will not be considered complete without payment of the appropriate fee for each tier under which you are operating. <br /> (Please note that the fee is per TIER not per UNIT. For example, if you operate S units but they are aU Conditionally Authorized, <br /> you only owe$1,140, NOT S timet$1,140. If you operate any Permit by Rule units and any units under Conditional Authorization <br /> you owe$2,280.) Checks should be made payable to the Department of Toxic Substances Control and be siapled to the top of this <br /> form. Please write your EPA ID Number on the check Fill in the check number in the bar above. <br /> L NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit specific not(cation forms you must ankh. <br /> ConditionaUy Exernpt Small Quantity Treatment operations may not operate unci under any other der. <br /> Number of units and attached unit specific notifications Fee per Tier <br /> (not per eWt) <br /> A. 0 Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. 1 Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) $ 100 <br /> y <br /> C. 0 Conditionally Authorized {Form DTSC 1772C) $1,140 <br /> m W X <br /> D. 0 Permit by Rule m 3 co (Form DTSC 1772D) $1,140 <br /> a:=== a W <br /> 4130 6o'a <br /> 1 Total Number of Units w 1 Total Fee Attached $ 100. 00 <br /> 11 GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CA L 0 0 0 0 3 2 2 7 1 BOE NUMBER (if available) HA HQ 3 6 0 3 5 7 9 4 <br /> f <br /> NAME (Company or Facility) San Joaquin Cogen <br /> (DBA—Doing Boaineu As) <br /> PHYSICAL LOCATION c/o Destec Operating Company (Operator) <br /> 17200 South Harlan Rd. <br /> CITY Lathrop CA ZIP 95330 - For DTSC Un only <br /> Region I <br /> COUNTY San Joaquin <br /> CONTACT PERSON Kim Meyer PHONE NUMBER(229)858 - 5129 <br /> (Fest Name) (tAn Name) <br /> Page 1 <br /> r,rcr 1'1l� (11931 <br />