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State of Cnliforvia •California EavironmeaW Prourboti Agawy Departs"t of Toxic Swami Cmvd <br /> Chat Number Page I of 22 <br /> g�, x.- 9 2 0 b'0 2 8 <br /> 03 yea•!k, IVL CIO 1 <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> For Use by Hazardous Waste Generators Performing Treatment In Initial <br /> Under Conditional Exemption and Conditional Authonzation, ❑ Revised <br /> and by Permit By Rule Facilities <br /> h <br /> 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 nonieation forms for each of the jour categories and an additional notification form for transportable treatment <br /> units (7TU'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_'. Pru your EPA ID Number on each page. Please provide all of the information requested, all fields must be <br /> completed except those that stare 'if different' or 'if available'. Please type the information provided on this jam 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 rhe fee is per TIER not per UNIT. For example, if you operate S units but they are all Conditionally Authorized, <br /> you only owe$1,140, NOT S times$1,140. If you operate any Permit by Rule units and any units under Conditional Authorization <br /> you owe 52,280.) Checks should be made payable to the Department of Toxic Substances Control and be stapled to the top of this <br /> form. 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 norifrcation forms you must aaach. <br /> Conditionally Isanpr Small Quaratuy Treatment operations may nor operate units under any otter tier. <br /> Number of units and attached unit specific notificatiore Fee per Tier <br /> ("I per urup <br /> A. 0 Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ 100 <br /> B. 6 Conditionally Exempt-Specified Wastestreatn (Form DTSC 1772B) $ 100 <br /> C. 0 Conditionally Authorized I I (Form DTSC 1772C) $1,140 <br /> ' <br /> D. 0 Permit by Rule (Form DTSC 1772D) $1,140 <br /> APR OF 1993 <br /> 6 Total Number of Units cawnm. j ,�_,*, Total Fee Attached $ 100 <br /> i..n7 <br /> ac;ros <br /> II. GENERATOR MENTIFICATION Sq ' <br /> CaAMENSO <br /> EPA ID NUMBER CA 2 1 7 0 0 2 4 3 8 2 BOE NUMBER (if available) H F HQ3 8 _21 0 4 3 2 <br /> NAME (Company or Facility) naval Communication Station Stockton <br /> (DBA—Douai Bueiaeea As) <br /> PHYSICAL LOCATION Rough and Ready Island <br /> For DISC Uee ONy <br /> CITY Stockton CA ZIP 95203 - 5000 <br /> a.aiao�_ <br /> COUNTY San Joaquin <br /> CONTACT PERSON Bruce _ James PHONE NUMBER2( 09 ) 944 - 0400 <br /> (Fut Name) (Its Name) <br /> DISC 1772 (1/93) EMCLOSUREN <br /> Page I <br />