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` Slate of Crfifornis-California EariroammW Pr on Aa—y Department of Tonic Suhatanco Caotxd k u r Page I of 5 ?6 3n6 ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM FACILITY SPECIFIC NOTIFICATION v For Use by Hazardous Waste Generators Performing Treatment ❑ Initial UUnder Conditional Exemption and Conditional Authorization, ® Revised y and by Permit By Rule Facilities n t j Please refer to the attached Instructions before completing this form. You may notify for more than one permitting tier by using this not fcation form, D7SC 1772. You must attach a separate unit specific not(cation form for each unit at this location. There are different unit specific not f cation forms for each of the four categories and an additional notification form for transportable treatment units (7T1f's). You only have to submit forms for the tier(s) that cover your unit(s). Discard or recycle the other unused form:. Number each page of your completed notification package and indicate the total number of pages at the top of each page at the 'Page — of_'. Put your EPA ID Number on each page. Please provide all of the information requested; all fields must be completed except those that state 'if different' or 'if available'. Please We the information provided on this form and any attachments. The notification will not be considered complete without payment of the appropriare fee for each tier under which you are operating. (Please note that the fee is per TIER not per UNIT. For example, if you operate 5 units but they are all Conditionally Authorized, you only owe$1,140, NOT S times$1,140. If you operate any Permit by Rule units and any units under Conditional Authorization you owe $2,280.) Checks should be made payable to the Department of Toxic Substances Control and be stapled to the top of this form. Please write your EPA ID Number on the check Fill in the check number in the box above. I. NOTIFICATION CATEGORIES Indicate the number of units you operate in each tier. This will also be the number of unit specific not f cation forms you must attach. ConditionaUy Exempt Small Quantity Treatment operations may not operate units under any other tier. Number of units and attached unit specific notifications Fee per Tim hux Per-tl A. 0 Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 B. 1 Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) $ 100 C. n Conditionally Authorized (Form DTSC 1772C) $1,140 D. 0 Permit by Rule (Form DTSC 1772D) $1,140 1 Total Number of Units Total Fee Attached $ 100.00 11. GENERATOR IDENTIFICATION 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 NAME (Company or Facility) San Joaquin Cogen (DBA—Doing Butimu As) PHYSICAL LOCATION c/o Destec Operating Company (Operator ) 17200 South Harlan Rd . Eor DTSC Use only CITY Lathrop CA ZIP 95330 Region COUNTY San Joaquin CONTACT PERSON Kim Meyer PHONE NUMBER 2< 09 )$5B - 5129 (First Name) (Lar Name) DTSC 1772 (1/93) PaQe 1