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EPA ID NUMBER CAD009115239 <br /> Page 2 of. 8 <br /> III. RADIOACTIVE MATERIALS OR WASTE <br /> YES NO <br /> ❑ © Does the facility use, store or treat radioactive materials or radioactive waste? <br /> IV. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or nvo SIC codes (a four digit number) that best describe your company's products, services, or industrial activity. <br /> Example. 7384 Photofinishing lab 7718 Industrial launderers <br /> First: 2841 Soaps & Detergents Second: 5169 Distribution <br /> V. PRIOR PERMIT STATUS: Check yes or no to each question. <br /> YES NO <br /> ® ❑ L Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? <br /> ❑ 0 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 /> ❑ 0 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 /> ❑ 0 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 /> VI. PRIOR ENFORCEMENT HISTORY: Not required from generators only notijying as conditionally exempt or as a <br /> commercial laundry. _ <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 any 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 <br /> copy of the cover sheet from each document. (See the Instructions for more information) <br /> VH. ATTACHMENTS: Anadvnentr are not required for Commercial Laundryfacilities. <br /> ® 1. A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries. <br /> ® 2. A trait specific notification form for each unit to be covered at this location. <br /> DTSC 1772 (1/95) Page 2 <br />