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State of California-California Environmental protection Agency Department of Toxic Substances Control <br /> TIERED PERMITTING PRASE I ENVIRONMENTAL ASSESSMENT CHECKLIST <br /> SECTION I:FACILITY INFORMATION <br /> Instructions:Complete the following descriptive information about your facility.This information accurately describes the location of your facility <br /> and establishes nailing and phone contacts. If facility location and mailing address are identical,you may put"same"into facility mailing address <br /> Spaces. <br /> Type of Pennit: Permit by Rule_ Conditional Authorization <br /> i. CURRENT FACILITY NAME: SulpeY!OV 7g,A- WaS/'1 <br /> PAST NAMES(Attach additional pages if necessary): C/!eM!Ca <br /> t. EPA I.D.NUMBER: CAL. 000300 /W <br /> 3. NAME OF FACILITY OWNER see definition of owner; T �/a <br /> 4. NAME OF FACILITY OPERATOR: YioY Ta"l Gid 4 <br /> 5. NAME OF PROPERTY OWNER; Car _Tai dT &1-4 r <br /> FFACILITY LOCATION ADDRESS: Sy joe r iOV TCiHPTREET: 2"144", <br /> ,t Hsi h Z S7`vee <br /> CITY: SA0 G IT/o,, <br /> COUNTY: yah mTou9o4i'h <br /> STATE: CCA ZIPCODE: 5�Z06 <br /> 7. FACILITY MAILING ADDRESS(if different from FACILITY LOCATION ADDRESS): <br /> STREET: /P. o, 8 d x 6036 <br /> CITY: 57toCIT 1,0 H <br /> STATE: CA ZIP CODE:: Zp 6 <br /> 8. FACILITY TELEPHONE NUMBER: t2 0 9 <br /> 9. FACILITY FAX NUMBER: ZOp 4-6G —A?S �1 <br /> 10. NAME OF FACILITY CONTACT PERSON: C h a rIeS I7 V/N OIA <br /> 1 I. TITLE OF FACILITY CONTACT PERSON: S i!e !"/Q n q e F- <br /> 12. PHONE NUMBER OF FACILITY CONTACT PERSON Z 0 cj) 3YI— 4-*S Z <br /> DISC 1151(06199) <br /> Please indicate total number of peg"__Lof16 <br /> f <br />