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I Stale of California-California Sari ental Protection Agency S ` Dcrlmeul of Toxic Substances Control Check Number ...- c Page I of t3 ONSITE IIAZARDOUS WASTE TREATMENT NOTIHCATION FORM x FACILITY SPECIFIC NOTIFICATION For Use by Hazardous Waste Generators Performing Treatment ® Initial Under Conditional Exemption and Conditional Authorization, ❑ Revised v and by Permit By Rule Facilities d h Please refer to the attached Instructions before completing this form. You may not f•for more than one permitting tier by using this notification form, DTSC 1772. You must attach a separate unit specific notification join for each unit at this location. There are different erent unit specific notificationforne for each of thefour categories and an additional not(cationjorsn for transportable trenuneut units ("1-1'(1's). You only have to submit forms for the der(s) that cover your unit(s). Discard or recycle the other unused jorna. Number each page of your completed notification package and indicate the total number of pages at the top of each page at the 'Page — of—'. Put your EPA ID Number on each page. Please provide all of the information requested; all fields must be completed except those that state 'f different' or 'if available'. Please type the information provided on this jonn and ally attachments. The notification will not be considered complete without payment of the appropriate fee for each tier under which you are operating. (Please note that the fee is per 77ER simper UNIT. For example, (f you operate 5 units but they are all Conditionally Authorized, you only owe$(,140, NOT 5 times$1,140. If you operate any Permit by Rule units and any units under Conditional Authorization you owe$2,280.) Checks should be made payable to the Department of Toxic Substances Control and be stapled to the top of this form. Please write your EPA ID Number oil the check. Fill in the check number in tire box above. I. NOTIFICATION CATEGORIES Indicate the number of units you operate in each tier. This will also be the number of unit specific ratification fours you must attach. Conditionally Exempt Small Quantity Treatment operations may not operate units under any other tier. Number of units and attached unit specific notifications Fee per Tier (not per unit) A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 B. 5 Conditionally Exempt-Specified Wastestream (Form DTSC 17728) $ 100 C. Conditionally Authorized (Form DTSC 1772C) $1,140 D. Permit by Rule (Form DTSC 1772D) $1,140 5 Total Number of Units Total Fee Attached $ 100 II. GENERATOR IDENTIFICATION EPA ID NUMBER CA L 0 0 0 0 2 2 6 9r 3 BOB NUMBER if available HF IIQ_2 8 0 0 1 9 5 8 !' NAME (Company or Facility) California Cedar Products (DBA--Doing Business As) PHYSICAL LOCATION 1340 W. Washington Street For DTSC Use Only CITY Stockton CA Z1p95203 _ 3138 Region COUNTY San Joaquin CONTACT PERSON Rod Gonzalez PHONE NUMBER( 209 ) 944 -5800 (First Name) (Lan Name) DTSC 1772 (1/93) Page 1