Laserfiche WebLink
EPA ID NUMBER CAL000107712 Page 2 of 6 <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME (DBA) ' <br /> STREET SAME <br /> A <br /> CITY STATE ZIP <br /> COUNTRY <br /> (ody complete if rqt USA) <br /> CONTACT PERSON PHONE NUMBER( <br /> (First Narne) (Lrt Name) <br /> Ifl. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a jour digit number) that best describe your company's products, services, or industrial acrivirv. <br /> Example: L Photo!inishine lab 3671 Printed circuit boards <br /> First: 8062 MED/SURG. HOSPITAL Second: <br /> IV. PRIOR PERAIIT STATUS: Check yes or no to each question: <br /> YES NO <br /> 11 © I. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? 000* <br /> © 2. Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim <br /> status for any of these treatment units? <br /> 3. Do you now have or have you ever held a state or federal full permit or interim status for any other <br /> hazardous waste activities at this location? <br /> ® 4. Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you <br /> are now notifying for at this location? <br /> ® 5. Has this location ever been inspected by the state or any local agency as a hazardous waste generator? <br /> V. PRIOR ENFORCEMENT HISTORY: Not required from generators only noting as conditionally umrpr, <br /> YES NO N/A <br /> ❑ Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or ftnal <br /> orders resulting from an action by any local, state, or federal environmental, hazardous waste, or public health <br /> enforcement agency? <br /> (For the purposes of this form, a notice of violation does not constitute an order and need not be reported unless <br /> it was not corrected and became a final order.) <br /> 0 If you answered Yes, check this box and attach a listing of convictions,judgments, settlements, or orders and a A <br /> of the cover, sheet from each document. (See the Instructions for more information) <br /> DTSC 1772 (1193) Page 2 <br />