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State of California.California Farimamental Prr -tion Agency Department of Toric Substances Control <br /> Che.ik Number �:�// Page 1 of <br /> 92 00014 <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> For Use by Hazardous Waste Generators Performing Treatment Initial <br /> V Under Conditional Exemption and Conditional Authorization, ❑ Revised <br /> 4 and by Permit By Rule Facilities <br /> c' <br /> r i Please refer to the attached Instructions before completing this form. You may noth for more than one permitting tier by using this <br /> nothcation form, DISC 1772. You must attach a separate unit specific notification form for each unit at this location. There are <br /> different unit specific notication forms for each of the four categories and an additional notificationform for transportable treatment <br /> units (ITV's). You only have to submit forms for the tier(s) that cover your unit(s). Discard or recycle the other unused forms. <br /> Number 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; all fields must be <br /> completed except those that state 'if different' or 'if available'. Please type the information provided on this form and any <br /> attachments. <br /> The notification will not be considered complete without payment of the appropriate fee far each tier under which you are operating. <br /> (Please note that the fee is per 77ER not per UNIT. For example, if you operate S units but they are all Conditionally Authorized, <br /> you only owe$1,140, NOT S times$1,740. If you operate any Permit by Rule units and 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 ID Number on the check. Fill in the check number in the box above. <br /> I. NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit specific notification forms you must attach. <br /> Conditionally Exempt Small Quantity Treatment operations may not operate units under any other tier <br /> Number of units and attached unit specific notifications Fee per Tier <br /> (rot per unit) <br /> A. 0 Conditionally Exempt-Small Qtt tment (Form DTSC 1772A) S 100 <br /> Toxic S <br /> B. 1 Conditionally Exempt-S iftedtve�� i� (Form DTSC 1772B) $ 100 <br /> Fm <br /> C. 0 Conditionally Autho ' m y ', c, Form DTSC 1772C) $1,140 <br /> D. 0 Permit by Rule A `a m = Form DTSC 1772D) $1,140 <br /> 1 Total Number of Units ?T0 N Total Fee Attached $100.00 <br /> IT. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CAD 9 8 1 6 6 4 5 9 2 _ BOE NUMBER (if available) HF HQ 3 8 0 0 2 2 7 1_ <br /> NAME (Company or Facility) Air Products and Chemicals , Inc. <br /> (DHA—Doing ausinen As) <br /> PHYSICAL LOCATION Stockton Cogen Facility <br /> 1010 Zephyr Street <br /> CITY Stockton CA ZIP 95206 =DTSCForIT OnlyCOUNTY San Joaquin <br /> CONTACT PERSON Alan Anderson PHONE NUMBER(---)--2 209 983903 0391 <br /> (Fina Name) (Lax Name) <br /> DTSC 1772 (1/93) Page 1 <br />