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I State of California-Califorala EVroumer 'rolectiou Agency (�/_ U Department of Took Substage"Coulrol <br /> Check Number G11'. — UEJ Page 1 of jj <br /> Z3 z� 9 2 0 0 0 ` 7 ,1' / w►1 �j <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> u - For Use by Hazardous Waste Generators Performing Treatment <br /> IN Initial <br /> Under Conditional Exemption and Conditional Authorization, ❑ Revised <br /> and by Permit By Rule Facilities <br /> d <br /> y Please refer to the attached Instructions before completing this form. You may notifyfor more than one permitting tier by using this <br /> notification jonn, DISC 1772. You must attach a separate unit specfe notification form for each unit at this location. There are <br /> different unit specific notiftcatioejorms for each ofthejour categories and an additional notificatiwnform for transportable treatment <br /> units (7TU's). You only have to submit forms for the tier(s) that cover your unhis). Discard or recycle the other unused forns. <br /> Nunber each page of your completed notification package and indicate the total number of pages at the top of each page at the <br /> 'Page _ of—'. Put your EPA ID Number on each page. Please provide all of the information requested; nil fredds :must be <br /> completed except those that state 'if different' or 'if available'. Please type the information provided on this jonn and any <br /> attachments. <br /> The notification will not be considered complete without payment of the appropriatefee far each tier under which you are operating. <br /> (Please note that the fee is per TIER not per UNIT. For example, if you operate 5 units but they are all Conditionally Authorized, <br /> you only owe $1,140, NOT S tuner$1,140. Ifyou operate any Permit by Rule units anal any units under Conditional Authorization <br /> you owe $2,280.) Checks should be made payable to the Department of Toxic Substances Control and be stapled to the top of this <br /> form. Please write your EPA 1D Number on the check. Fill in the check number in the box above. <br /> I. NOTIFICATION CATEGORIES <br /> Indicate the number of writs you operate in each tier. 7h1s will also be the number of unnit specific nnotlfication forms you must mach. <br /> Conditionally Exempt Small Quantity 7)-eatment operations may not operate units under any other tier. <br /> Number of units and attached unit specific notifications Fee per Tier <br /> (nor per unit) <br /> A. Conditionally Exempt-Small gunfil fy;rReeRttuenl (Form DTSC 1772A) $ 100 <br /> B. 5 Conditionally Exempt(�bcl�4SiWastestreahtrB9aA (Form DTSC 17728) $ 100 <br /> C. Conditionally Authori ? orm DTSC 1772C) $1,140 <br /> D. Permit by RuleR O 1993 orm DTSC 1772D) $1,140 <br /> oHealth Semlw$ <br /> 5Total Number of UnitcRAIAV%" Total Fee Attached $ 1-o0 <br /> IL GENERATOR IDENTIFICATION T <br /> EPA ID NUMBER CA L 0 0 0 0 2 2 6 9 3� BOB NUMBER (if available) Q <br /> HF II 3 8 0 0 1 9 5 8 <br /> ---�--- -- -- — -- ------ <br /> NAME (Company or Facilili California Cedar Products <br /> (DBA--Doing Business As) <br /> PHYSICAL LOCATION 1340 W. Washington Street <br /> For DTSC Use Only <br /> CITY Stockton CA ZIp95203 i- 3138 I <br /> Region <br /> COUNTY San Joaquin <br /> CONTACT PERSON Rod Gonzalez PHONE NUMBER 2( 09 ) 944 5800 <br /> (First Name) (Last Name) <br /> DTSC 1772 (1/93) Page I <br />