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UNIDOCS <br />FACILITY INFORMATION <br />BUSINESS ACTIVITIES PAGE <br />Page of <br />I. FACILITY IDENTIFICATION <br />FACILITY ID # <br />EPA ID # (Hazardous Waste Only) <br />(Agency Use Only) <br />BUSINESS NAME (Same as FacilitiNeime yr DRA - Doing Business As) <br />T—MOBILE WEST CORPORATION SITE ID#SC13367B <br />BUSINESS SITE ADDRESS 647 WEST LINDSAY STREET 103 <br />BUSINESS SITE CITY STOCKTON 104-CA <br />I ZIPCODE 95203 los. <br />II. ACTIVITIES DECLARATION <br />NOTE: if you check YES to any part of this list, <br />lease submit the Business Owner/ O erator Identification page. <br />Does your facility... <br />If Yes, please complete these pages of the UPCF... <br />A. HAZARDOUS MATERIALS <br />Have on site (for any purpose) at any one time, hazardous materials at or <br />above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for <br />compressed gases (include liquids in ASTs and USTs); or the applicable <br />YES ®NO a. <br />HAZARDOUS MATERIALS INVENTORY - <br />Federal threshold quantity for an extremely hazardous substance specified in <br />CHEMICAL DESCRIPTION <br />40 CFR Part 355, Appendix A or B; or handle radiological materials in <br />quantities for which an emergency plan is required pursuant to 10 CFR Parts <br />30 40 or 70? <br />B. REGULATED SUBSTANCES <br />Have Regulated Substances stored onsite in quantities greater than theCoordinate <br />❑YES ®NO <br />with your local agency responsible for <br />threshold quantities established by the California Accidental Release <br />CaIARP. <br />Prevention Program CalARP ? <br />C. UNDERGROUND STORAGE TANKS (USTs) <br />UST OPERATING PERMIT APPLICATION - <br />Own or operate underground storage tanks? <br />❑ YES (N NO s <br />FACILITY INFORMATION <br />UST OPERATING PERMIT APPLICATION - <br />TANK INFORMATION <br />D. ABOVE GROUND PETROLEUM STORAGE <br />Own or operate ASTs above these thresholds: <br />YES NO s. <br />No form required to CUPAs <br />Store greater than 1,320 gallons of petroleum products (new or used) in <br />aboveground tanks or containers? <br />E. HAZARDOUS WASTE <br />Generate hazardous waste? <br />❑ YES ® NO v. <br />EPA ID NUMBER - provide at top of this page <br />Recycle more than 100 kg/month of excluded or exempted recyclable <br />❑ YES ® NO to. <br />RECYCLABLE MATERIALS REPORT <br />materials (per HSC §25143.2)? <br />(one per nxyder) <br />Treat hazardous waste onsite? <br />[]YES ® NO 11. <br />ONSITE HAZARDOUS WASTE TREATMENT <br />NOTIFICATION - FACILITY PAGE <br />ONSITE HAZARDOUS WASTE TREATMENT <br />NOTIFICATION - UNIT PAGE (one page per unit) <br />Perform treatment subject to financial assurance requirements (for Permit by <br />❑ YES ® NO a. <br />CERTIFICATION OF FINANCIAL ASSURANCE <br />Rule and Conditional Authorization)? <br />Consolidate hazardous waste generated at a remote site? <br />❑ YES ® NO ts. <br />REMOTE WASTE CONSOLIDATION SITE <br />ANNUAL NOTIFICATION <br />Need to report the closure/removal of a tank that was classified as hazardous <br />❑ YES ® NO 14. <br />HAZARDOUS WASTE TANK CLOSURE <br />waste and cleaned onsite? <br />CERTIFICATION <br />Generate in any single calendar month 1,000 kilograms (kg) (2,200 <br />❑ YES ®NO 14a. <br />Obtain federal EPA ID Number, file Biennial <br />pounds) or more of federal RCRA hazardous waste, or generate in <br />Report (EPA Form Large Quant and satisfy <br />requirements for RCRA Large Quantity Generator. <br />any single calendar month, or accumulate at any time, I kg (2.2 <br />pounds) of RCRA acute hazardous waste; or generate or accumulate <br />at any time more then 100 kg (220 pounds) of spill cleanup materials <br />contaminated with RCRA acute hazardous waste? <br />Serve as a Household Hazardous Waste HW Collection site? <br />❑ YES IN NO tan. <br />See CUPA for required forms. <br />F. LOCAL REQUIREMENTS (You may also be required to provide additional infonnation by your CUPA or local agency.) 1$' <br />UN -020 www.unidocs.org 3/17 - Rev. 12/1.4/10 <br />