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EPA ID NUMBER CAr�nn - �o59 Page 2 of?5 <br /> MAILING ADDRESS, IF DFFFERENT: <br /> COMPANY NAME (DBA) 4P, 1te_G4 4rvs acc— 5-hYuc-Xt rcS amp <br /> STREET PO Box 6189 <br /> D[8'cj <br /> CITYStyx ktnn STATE �_ ZIP - <br /> COUNTRY <br /> (only complcte if not USA) <br /> U c.-A_i d d <br /> CONTACT PERSON _Lon -tea:,tea PHONE NUMBER 2( O9 ) 983 -4a39- <br /> (First Name) (bast Namc) <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a four digit number) that best describe your company's products, services, or industrial activity. <br /> Example: 7384 Photofinishing lab 3672 Printed circuit boards <br /> First: 3728 Aircraft parts, n.e.c. Second: 3769 Space vehicle parts, n.e.c. <br /> 1V. PRIOR PERMIT STATUS: Check yes 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 /> ❑ 13 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 /> El ❑ 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 IIISTORY: Not required from generators only notifying ar conditionally eranpt. <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 /> MV <br /> Lai 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 />