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State of CaUornia-California Ecvuonmentat Protwtioo Agency Departmem of Toxic Sobstaocs Ctntrd <br /> Page I of 3 <br /> 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, ❑ Renewal <br /> and by Permit By Rule Facilities ® Amendment <br /> Please refer to the anadwd Instructions before complaing this form. You may nosh for more than one permitting tier by using this <br /> not fication form, D73C 1772. You must attach a separate unit specific notification form for each unit at this location. There ars <br /> d fferem unit specific not ficarion forums for each of the four categories and an additional nor fication form for transportable treatment <br /> units (ITV's). You only have to submit forms for the tiers) 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 LD 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 nor fication fees are assessed on the basis of the number of tiers the not fier will operate under, and will be collected by the State <br /> Board of Equalization. DO NOT SEND YOUR FEE V= 771IIS N077FICA770N FORM. <br /> I. NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. 7his will also be the number of unit specific not fication forms 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 for each tier reported. <br /> A. Conditionally Exempt-Small Quantity Treatment D. 2 Permit by Rule <br /> B. Conditionally Exempt-Specified Waste-stream E. Commercial Laundry <br /> C. Conditionally Authorized F. Variance (Section 25143) <br /> U. 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 /> (DBA-DoingBusimu As) <br /> PHYSICAL LOCATION 1848 & 1856 Field Avenue <br /> CITY Stockton CA 7jp 95203 <br /> COUNTY San Joaquin <br /> CONTACT PERSON Lloyd Finley PHONE NUMBER 2( O9 )466 - 1957 <br /> (Fust Name) (La Name) -- <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME Tigma Circuits Inc , Citation Division rorDrSCUwOnly <br /> STREET 1950 W. Fremont St . Regan <br /> CITY Stockton STATE CA ZIP 95203 <br /> COUNTRY <br /> (Ord complete if rot USA) <br /> CONTACT PERSON )rloyd Finley PHONE NUMBER 2( O9 )466 -_1957 <br /> (Fire Nam) (LAx Namc) <br /> DTSC 1772 (1/95) Page I <br />