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State of California-California Environmental Protecting Agcy Department or Toric SuEatancm Cowrd <br /> Page 1 of 3 <br /> I ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION , <br /> For Use by Hazardous Waste Generators Performing Treatment 0 initial <br /> Under Conditional Exemption and Conditional Authorization <br /> •0 A• -ter r- ❑ R'eaewal <br /> Cy <br /> and by Permit By Rule Facilities Immilmeat <br /> Please refer to the attached Inrrru xions before completing this form. You may nam for more than one permitting tier by using this <br /> notification form, D7SC 1772. You must attach a separate unit specific not fication form fol eabK gni{qt-th+s ioehriOn. Dtere are <br /> different unit specific norication forms jar each of the four categories and an additional not ficatioh form for transportable treatment <br /> units (I7V's). You only have to submit forms for the der(s) that cover your unit(y). Discard or recycle the other unused forms. <br /> Number each page of your completed rot ficatian package and indicate the total number of pages at the top ojr each page ar 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 notificationfees are assessed on the basis of the number of tiers the notifier will operate under, and will be collected by the State <br /> Board of Equalization. DO NOT SEND YOUR FEE WrM 777IS N077ICA770N 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 must attach. <br /> Conditionally Exempt Small Quantity Treatment operations may not operate uniu under any other her <br /> Number of units and attached tacit specific notifications for each tier reported. <br /> A. Conditionally Exempt-Small Quantity Treatment D. 2 Permit by Rule <br /> B. Conditionally Exempt-Specified Wastestream E. Commercial Laundry <br /> C. Conditionally Authorized F. Variance (Section 25143) <br /> IL GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CAD 9 8 2 3 7 06 2 9 BOE NUMBER (if available) H_HQ_ <br /> FACILITY NAME Sigma Circuits Inc , Citation Division <br /> (DSA-Doing9unmu As) 1848 & 1856 Field Avenue <br /> PHYSICAL LOCATION <br /> CITY Stockton CA 7IP 95203 _ <br /> COUNTY San Joaquin <br /> CONTACT PERSON Lloyd Finley PHONE NUMBER 2( O9 )466 - 1957 <br /> m <br /> Tirx Nae) (Lm <br /> ae Nae) -- <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAMEsigma Circuits Inc, Citatio:h Division For DTSC�y <br /> STREET 1950 W. Fremont St . Segwe <br /> CITY Stockton STATE CIS ZIP 95203 <br /> COUNTRY <br /> (ool coapleu if not USA) <br /> CONTACT PERSON Zloyd Finley PHONE NUMBER 2( 09 )466 -_1957 <br /> (Prat Naas) (tan Namc) <br /> DTSC 1772 (1/95) Page 1 <br />