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State of California-California FDariro metal Protection Agency Department of Toric Substances Control <br /> Check Number - Page 1 of :40 <br /> 2213992 <br /> i <br /> i <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTICATION FORM <br /> w FACILITY SPECIFIC NOTIFICATION Q j gyp,^, <br /> For Use by Hazardous Waste Generators Performing Treatment APR <br /> J Initial <br /> FmNVIR0NMFNTA.L LTH <br /> FR <br /> U Under Conditional Exemption and Conditional AuthorizatiorlMlfi/J RVI Revised <br /> a+ <br /> and by Permit By Rule Facilities E <br /> i7 <br /> t� Please refer to the attached Instructions before completing this form. You may notes for more than one permitting tier by using this <br /> notification form,D7SC 1772. You must attach a separate unit specific notification form for each unit at this location. There are <br /> different unit specific notification forms for each of thefour categories and an additional not ficationform for transportable treatment <br /> units (TTY s). You only have to submit forms for the tier(s) that cover your unit(s). Discard or recycle the other unused forms. <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 fields 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 77ER not per UNIT. For example, if you operate 5 units but they are all Conditionally Authorized, <br /> you only owe$1,140, NOT 5 times$1,140. /f 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 stapled to the top of this <br /> form. Please write your EPA ID Number on the check. Fill in the check number in the box above. <br /> I. 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 attach. <br /> Conditionally Exempt Small Quantity Treatment operations may not operate units under any other tier <br /> Number of units and attached unit specific notifications Fee per Tier <br /> (not per wit) <br /> A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. �_ Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) $ 100 <br /> C. �- Conditionally Authorized (Form DTSC 1772C) $1,140 <br /> D. 4 Permit by Rule (Form DTSC 1772D) $1,140 <br /> 4 Total Number of Units Total Fee Attached $ 1140 <br /> H. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CAD__D0_ LL 3_ 91_Q BOE NUMBER (if available) HG_HQ 3 L L 4 2 5 8 4 <br /> NAME (Company or Facility) NESTLE BEVERAGE COMPANY <br /> (DBA—Doing Business As) <br /> PHYSICAL LOCATION RIPON SITE <br /> 230 INDUSTRIAL AVE . <br /> For DTSC TJse Only <br /> CITY RIPON CA ZIP 95366_ <br /> Region <br /> COUNTY SAN JOAQUIN <br /> CONTACT PERSON JOHN MELING PHONE NUMBER2( 09 )599 _ 4161 <br /> (First Name) (last Name) <br /> DTSC 1772(1/93) Page 1 <br />