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Stue of.California-California Fnviroummtal Protection Agency Department of Toxic Subsume,Control <br /> • Chect Numbcr Page 1 of 9 <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> For Use by Hazardous Waste Getiefators PerfdrnlinL'lteatmeru Initial <br /> j Under Conditional Exemption and Conditional Authorization, ❑ Revised <br /> v and by Permit By Rule Facilities <br /> y <br /> Please refer to the attached Instructions before completing this form. You may not for more than one permitting tier by using this <br /> notification jorm, DISC 1772. You must attach a separate unit specific notification form for each unit at this location. There are <br /> different unit specific notification forms for each of the four categories and an additional not fcationform for transportable treatment <br /> units ('DTI's). You only have to submit forms for the tier(s) that cover your unit(s). Discard or recycle the other unused forms. <br /> Number each page of your completed notification package and indicate the total number of pages at the top of each page at the <br /> '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 farm and any <br /> attachments. <br /> The notification will not be considered complete without payment of the appropriatefee for each tier under which you are operating. <br /> (Please note that the fee is per 77ER not per UNIT. For example, if you operate 5 units but they are all Conditionally Authorized, <br /> you only owe$1,140, NOT5 timer$1,140. If you operate any Permit by Rule units and any units under Conditional Authorization <br /> you owe$2,280.) Checks should be made payable to the Department of Toxic Substances Control and be stapled to the top of this <br /> form. Please write your EPA ID Number on the check Fill in the check number in the box above. <br /> L NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit specific notificationforms you must attach. <br /> Conditionally Exempt Small Quantity Treatment operations may not operate units under any other tier. <br /> Number of units and attached unit specific notifications Fee per Tier <br /> (not per unit) <br /> A. 1 Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) $ 100 <br /> C. Conditionally Authorized (Form DTSC 1772C) $1,140 <br /> D. Permit by Rule (Form DTSC 17721D) $1,140 <br /> 1 Total Number of Units Total Fee Attached $ 100.00 <br /> IL GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CA 6 1 8 0 0 9 0 4 7 8 BOE NUMBER if available H AHQ 3 6 0 4 7 7 6 2 <br /> NAME (Company or Facility) U.S. Postal Service <br /> (DBA—Doing Business As) <br /> PHYSICAL LOCATION <br /> 3131 Arch Airport Road <br /> For DTSC Use Only <br /> CITY Stockton CA ZIP 95213 _ 9890 <br /> Region <br /> COUNTY San Joaquin <br /> CONTACT PERSON Patrick Scholzen PHONE NUMBER( 209) 983 _ 6316 <br /> (First Name) (Iaq Name) <br /> DTSC 1772 (1/93) Page I <br />