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EPA M NUMBER L-4,06 o 3/�—O 7 Page 2 of�4. <br /> MAILING ADDRESS, IF DIFFERENT: <br /> )MPANY NAME (DBA) SHELL O!L G4yi//A/v!/ <br /> STREET ( N &00,e//t/Rar si <br /> P o Qox yByR <br /> CITY AV4H !M STATE C4 ZIP Wfflo3 - <br /> COUNTRY <br /> (o'Jy complete if not USA) <br /> CONTACT PERSON �E�1tErV1,tAA0r PHONE NUMBER(?/57 ) <br /> (Fuca Noma) (Loa Name) <br /> III, TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC coder (a four digit number) that best describe your company's products, services, or industrial activity. <br /> Example: 7384 Photofinishing lab 3672 Primed circuit boards <br /> First </71 44,46< sr.ncc 01_j7iraurroN Second: <br /> TV. PRIOR PERMIT STATUS: Check yes or no to each question: <br /> ES NO <br /> ❑ 1. Did you file a PBR Notice of Intent to Operate (DISC Form 8462) in 1992 for this location? <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 gmerators only noti ing as conditionally CaMP. <br /> YES NO <br /> ❑ Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final <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 /> ❑ If you answered Yes, check this box and attach a listing of convictions,judgments, settlements,or orders and a copy <br /> of the cover sheet from each document. (See the Instructions for more information) <br /> Page 2 <br /> DTSC 1772 (1/93) <br />