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State of California • Califarnia Earvvnra®t: ateetion Agency Check Number "' v Department of Toxic Suhaastcet Co9 / -O �i i`� Page l off 9 v � 2 00026 ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM FACILITY SPECIFIC NOTIFICATION For Use by Hazardous Waste Generators Performing Treatment ® Initial Under Conditional Exemption and Conditional Authorization, ❑ Revised and by Permit By Rule Facilities Please refer to the attached Instructions before completing orm. You � P 8 this f may notes for more than one permitting tier by using this notification form, DISC 1772. You must attach a separate unit specific notification form for each unit at this location. There are different unit specific notificationformsfor each of rhe jour categories and an additional notification form for transportable treatment units (77TI's). You only have to submit forms for the rier(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 77ER not per UNIT: For example, if you operate 5 units but they are all Conditionally Authorized, you only owe$1,140, NOT S time:$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 notification forms you must attach. Conditionally F-zempt Small Quantity Treatment operations may not operate un(tr under any odter tier. Number of units and attached unit specific notifications Fee per Tier no,per u vu A. 0 Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ too B. 0 Conditional) Exempt-Specified °` '' Y P pacified e. .,, :- r„ (F�rm DTSC 1772B) $ I00 C. 0 Conditionally Authorized . `' (Foto,DTSC 1772C) $1,140 D. 1 Permit by Rule (Form TSC 1772D) 51.130 APR 011993 C-l";."'a tbp"Imont 1 Total Number of Units °t '« ssrvices Total Fee Attached S 1 , 140 II. GENERATOR IDENTIFICATION Sf�A A M ENS 0 EPA ID NUMBER CAL 9 3 0 6 0 3 6 0 8 BOE NUMBER (if available) H_HQ__ NAME (Company or Facility) Olin Corporation (DBA—Doing Business As) PHYSICAL LOCATION 544 Industrial Park Drive For DTSC Use Only CITY Manteca CA ZIP 95336 - C Region COUNTY San Joaquin CONTACT PERSON David Butler PHONE NUMBERzf 09 )824 _ 1 16 6 (First Name) (Lst Name) DTSC 1772 (1193) Page l