Laserfiche WebLink
EPA ID NUMBER CAL000043078 Page 2 of o <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME (DBA) LODI MEMORIAL HOSPITAL <br /> STREET 975 S. Fairmont Ave. <br /> P.O. Box 3004 <br /> CITY Lodi STATE CA Zip 95241- <br /> COUNTRY San Joaquin <br /> (oNy complete if n USA) <br /> CONTACT PERSON Dennis Marlow PHONE NUMBER(209 ) 339_7573 <br /> (Fire Nuns) (Lu Name) <br /> i <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> i <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 Photofinirhine lab 3671 Printed circuit boards <br /> First: 0862 Med/Sorg Hos i a Second: <br /> IV. PRIOR PERI1iUT STATUS: Check yes or no to each question: <br /> YES NO <br /> ❑ ® 1. Did you file a PBR Notice of Intent to Operate (DTSC 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 /> ❑ R❑ 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 /> ❑ 0 5. Has this location ever been inspected by the state or any local agency as a hazardous waste generator? <br /> V. PRIOR ENFORCENI ENT HISTORY: Not required from generators only nothing as conditionally exempt. <br /> YES NO 4- - ' <br /> ❑ ❑ Within the list 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 a <br /> of the cover sheet from each document. (See the Instructions for more information) <br /> DTSC 1772 (1/93) Page 2 <br />