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Page 2 of Q1' <br /> EPA ID NUMBER CA•DDoe.../SO7 .� <br /> MAILING ADDRESS, IF DIFFERENT: <br /> )MPANY NAME (DBA) 'SfFELL 0/1- <br /> STREET <br /> ILSTREET ,5-(L V RRaoeda sr S% <br /> P o QoxRyR <br /> CITY n •re NF/M STATE 12 ZIP 918 <br /> COUNTRY <br /> (ody complete if ow USA) <br /> CONTACT PERSON /2oN <br /> 1Nf/4AOT PHONE NUMBER()/4— -LL - 33BS <br /> (Piro Name) <br /> (tyt Name) <br /> M. 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 activity. <br /> Example: 7384 Photofinishing lab 3671 Printed circuit boards <br /> First: 5/71 huEt S SfoFA4E r OtsTR1&rtcv Second: <br /> IV. PRIOR PERMIT STATUS: Check yes or no to each question: <br /> FS NO <br /> 1. Did you file a PBR Notice of Intent to Operate (DTSC Form 9462) in 1992 for this location? <br /> El❑ 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. <br /> enerator?V. PRIOR ENFORCEMENT HISTORY: Not required from generators only notifying as condldionally exempt. <br /> YES NO " <br /> Within the list three years, has this facility been the subject of any convictions, judgments, settlements, or foul <br /> ❑ rA <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 />