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State of California-California Environmental Protection Agency Department of Toxic Substances Control <br /> Page 1 of 3 <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFIC ON ,� <br /> U FACILITY SPECIFIC NOTIFICATION N'. .YnitiN <br /> 1 Mv For Use by Hazardous Waste Generators Performing Treatme t ` 11Amelt <br /> kOPLI !D C t L "y_qt Under Conditional Exemption and Conditional Authorization, Dc. '3 <br /> and by Permit By Rule Facilities 1 D91996 =1 <br /> Please refer to the attached Instructions before completing this form. You may notify for more th*orle permitting tier by usire <br /> this <br /> notification form, DTSC 1772. You must attach a separate unit specific notification form for each hait-4f Ais location. are <br /> different unit specific notification forms for five of the categories and an additional notification form for &i Pet nt units <br /> (7TU's). You only have to submit forms for the tier(s)1category(ies) that cover your unit(s). Discard or recyc a the other unused <br /> forms. Number each page of your completed notification package and indicate the total number of pages at the top of each page at <br /> the `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 fees are assessed on the basis of the highest tier the notifier will operate under and will be collected by the State <br /> Board of Equalization. DO NOT SEND YOUR FEE PAYMENT WITH THIS NOTIFICATION FORM. <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 <br /> must attach. Conditionally Exempt Small Quantity Treatment operators may not operate units under any other tier. <br /> Number of units and attached unit specific notifications for each tier reported. <br /> A. Conditionally Exempt-Small Quantity Treatment (CESQT) D. Permit by Rule (PBR) <br /> B. Conditionally Exempt-Specified Wastestream (CESW) E. CE--Commercial Laundry (CE-CL) <br /> C. Conditionally Authorized (CA) F. 2 Conditionally Exempt-Limited (CEL) <br /> II. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CAQ Q 2 Q__L !_L a_3_L_ BOE NUMBER (if available) HA HQ3_�L Q_ <br /> FACILITY NAME DANA CORPORATION <br /> (DBA—Doing Business As) <br /> PHYSICAL LOCATION 1550 Industrial Drive <br /> CITY Stockton CA ZIP 95206 _ <br /> COUNTY San Joaquin <br /> CONTACT PERSON Raul Ragunton PHONE NUMBER(209 )983 - 6100 <br /> (First Name) (Last Name) <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME <br /> STREET <br /> CITY STATE ZIP - <br /> COUNTRY <br /> (only complete if not USA) <br /> CONTACT PERSON PHONE NUMBER( ) - <br /> (First Name) (Last Name) " <br /> DTSC 1772 (1/96) Page 1 <br />