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�T+rofCaifarav.Cal fornia Earirvmmmtal Protection ytency Departmat of Twee Suhetames Cowrd <br /> Page I of 2 <br /> v ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> For Use by Hazardous Waste Generators Performing Treatment ❑ Initial <br /> Under Conditional Exemption and Conditional Authorization, ❑ Revised <br /> Q and by Permit By Rule Facilities <br /> h Please refer to the attached Instructions before completing this form. You may notify for more than one permitting tier by using this <br /> notification form, 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 notification form for transportable treatment <br /> units ='s). You only have to submit forms for the rier(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 form and any <br /> attachments. <br /> The noOeation will not be considered complete without payment of the appropriate fee 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 51,140, NOT S lbws SI,140. If you operate any Permit by Rule units and any units ureter Conditional Authorization <br /> you owe$2,260.) Checks should be made payable to the Department of Toxic Substances Control and be stapled to the top of this <br /> fors. Please write your EPA ID Number on the check. Fill in the check number in the box abohm. <br /> L NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit specific notification fors you must attach. <br /> Cowdhtowalty Ekes"3waU Quantity Treatment operations may not operate units under any oder her <br /> Number of traits hard attached emit specific notifications Fee per Tier <br /> (,wt per amt) <br /> A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. 1 Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) =$ 100 <br /> C. Conditionally Authorized (Form DTSC 1772C) $1,140 <br /> D. Petmit by Rule (Form DTSC 1772D) $1,140 <br /> 1 Total Number of Units Total Fee Attached $ 100.00 <br /> IL GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CAD981577059 ---- - BOE NUMBER (if available) Hy HQ-3 6011341 <br /> NAME (Company or Futility) Tri Valley Growers <br /> (DBA—Doig Sola As) <br /> PHYSICAL LOCATION Plant 4 <br /> 3200 East Eight Mile Road <br /> For DTSC Use Only <br /> CITY Stockton CA zip 95212 <br /> fiction <br /> COUNTY San Joaquin <br /> CONTACT PERSON Jeff Wong PHONE NUMBER( 209 ) 931 _ 1531 <br /> (Finn Name) (Lam Nam) <br /> DTSC 1772 (1/93) Page t <br />