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Stale of California-California EnTironment, rotation Agency Department of Toxic Substances Control check Number ., ,. Page 1 of .40 2:«6992 9 2 0 0 0 1 8 2-1 ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM ^� FACILITY SPECIFIC NOTIFICATION u For Use by Hazardous Waste Generators Performing Treatment ❑ Initial U Under Conditional Exemption and Conditional Authorization, Revised and by Permit By Rule Facilities tl A Please refer to the attached Instructions before completing this form. You may notifyfor more than one permitting tier by using this notificadon form, DISC 1772. You must attach a separate unit specific notification form for each unit at this location. There are different unit specific notificationforinsfor each of the four categories and an additional notificationform for transportable treatment units (7TU's). You only have to submit forms for the tier(s) that cover your unit(s). Discard or recycle the other unused forms. 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 type the information provided on this form and any attachments. The notification will not be considered complete without payment of the appropriate 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 5 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. Conditionally Exanpt Small Quantity Treatment operations may not operate units under any other tier. Number of units and attached unit specific notifications Fee per Tier (not per unit) A. o Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 B. n Conditionally Exempt-$pecked Wastestream ,p-o (Form DTSC 1772B) $ 100 C. Conditionally Authorisedai 01 1983 (Form DTSC 1772C) $1,140 c- D. 4 Permit by Rule aI" %65sea','TPnt (Form DTSC 1772D) $1,140 C 9g1WENro 1140 4 Total Number of Units Total Fee Attached $ II. GENERATOR IDENTIFICATION EPA ID NUMBER CAa__D 0_1 LL L-9—L Q BOE NUMBER (if available) HG HQ 360 0 4 2 5 8 4 NAME (Company or Facility) NESTLE BEVERAGE COMPANY (DBA—Doing Business As) PHYSICAL LOCATION RIPON SITE 230 INDUSTRIAL AVE . For DTSC Use Only CITY RIPON CA ZIP 95366_ / Region COUNTY SAN JOAQUIN CONTACT PERSON JOHN METING PHONE NUMBER( 09 )599 _ 4161 (First Name) (IASL Name) DTSC 1772 (1/93) Page 1