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State of Callfa(9uk-Califortia Fartra rtal Frotect—Agcy Depart of Tads Saihtaocer Coma <br /> Check umber Page l of 22 <br /> ✓ J <br /> v <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION APR 0 �� <br /> For Use by Harardous Waste Generators Performing Treatment Initial <br /> Under Conditional Exemption and Conditional Authonntidd., tri MFNTAE tj�. -- <br /> and by Permit By Rule Facilities PERO1!IT/cItr?V <br /> h <br /> Please refer to the atrached Instructions before completing this form. You may notify for more than one permitting tier by using this <br /> notification form, D7SC 1771. 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 jour categories and an additional notifrcationform for transportable treatment <br /> units (77V'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 m 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 notification 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 T7ER not per UNIT. For example, if you operate 5 units but they are all Conditionally Authorized, <br /> you only owe 51,140, NOT S timer 51,140. 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 /> Jam. Please fill in the check number in the box above. <br /> I. NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit specific notifscation forms you must attach. <br /> Conditionally Exampr Small Quantity Trraaxm operations may rot operate um u under any odter tier. <br /> Number of [nits and attached unit specific notifications Fee per Tier <br /> Gwt per sawn <br /> A. 0 Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. 6 Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) S 100 <br /> C. 0 Conditionally Authorized (Form DTSC 1772C) $1.140 <br /> D. 0 Permit by Rule (Form DTSC 1772D) SI,140 <br /> 6 Total Number of Units Total Fee Attached S 100 <br /> II. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CA 2 1 7 0 0 2 4 3 8 2 BOE NUMBER (if available) H F IIQ3 8 0 0 0 4 3 2 <br /> NAME (Company or Facility) 11aval Communication Station Stockton <br /> (Dew–Doing Btu nea As) <br /> PHYSICAL LOCATION Rough and Ready Island <br /> For DTSC Ua ONy <br /> CITY Stockton CA Zip 95203 - 5000 <br /> w� <br /> COUNTY San Joaquin <br /> CONTACT PERSON Bruce James PHONE NUMBER2( Oy ) 944 _ 0400 <br /> (Fut Name) (Lt Name) <br /> Fra.e IEN <br /> DTSC 1772 (1/93) Page 1 <br />