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EPA ID .NUMBER CPLD ooq 14! 9Z9 Page s of <br /> MAILING ADDRESS, IF DlTnRENT: <br /> COMPANY NAhIE (DBA) Ol tPUc Z �� iu s Gras$ ��n+�3iNer � T.� <br /> STREET P t� R X 2 C <br /> CITY Ta acu STATE C� ZIP 95-378 <br /> COUNTRY <br /> (only complete if not USA) <br /> CONTACT PERSON 8116 Ne-ml PHONE NUMBER S/J 734- /2 7/e <br /> (Fra Name) (Lda Name) <br /> in. 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 Photohnishine lab 3671 Primed circuit boards <br /> First: 32.11 C41ass Cero+ai"erYs Second: <br /> IV. PRIOR PERMIT STATUS: Check ves 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 /> ❑ ® 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 /> ❑ IR 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. PRIOR ENFORCEMENT HISTORY: Not required from gen atom only notifying as conditionally evempt. <br /> YES NO <br /> ❑ ❑ Within the last three years, has this facility been the subject of any convictions,judgments, settlements, or final <br /> orders resulting from an action by anv 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 /> DTSC 1772 (1/93) Page 2 <br />