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Page [ of , <br /> EPA M ' MBER CAL00012c . $._� <br /> III. RADIOACTIVE MATERIALS OR WASTE <br /> YES NO <br /> ❑ ® Does the facility use. store or treat radioactive materials or radioactive waste'? <br /> lr. TYPE OF COMPANY. >rANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use tither one or two SIC order /-, ,our digit number) char best describe your company's products, sernh <br /> �ndustriai acxiviry. <br /> Example: 2M affg tnirhine lab BL$ Industrial lmada i <br /> First: 7384 Photofinisi._::J Lab Secmd: <br /> V. PRIOR PERMIT STATUS: Check yes or no to each question: <br /> YES NO <br /> ❑ ❑ 1. Did you file a PBR Notice of Intent to Operate (DISC Form 8462) in 1992 for this location? <br /> ❑ ❑ 2. Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim <br /> clams for any of these treatment units? <br /> ❑ ❑ 3. Do you now have or have you ever held a state or federal full permit or interim scams for any other <br /> hazardous waste activities at this location? <br /> ❑ ❑ 4. Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment <br /> are now notifying for at this location? <br /> ❑ ❑ 5. Has this location ever been inspected by the state or any local agency as a hazardous waste generator? <br /> VI. PRIOR ENFORCEMENT IIISTORY: Not regrdred front geno tors only notifying as mdidan°lly exernpr or at a <br /> oantnervd lar ndry. <br /> YES NO <br /> ❑ ❑ Within the last three years, has this faciliri Yea the subject of any convictions. judgments. settlements. or fuel <br /> orders molting from an action by any loco. state, or federal environmental, hazardous waste, or public health <br /> enforcement agency? <br /> (For the purposes of this form, a notice of violation does not constitute an order and need not be reported unles <br /> it was not corrected and became a foul order.) <br /> ❑ If you answered Yes, check this box and attach a listing of convictions, judgments, settlements. or orders and' <br /> copy of the cover sheet from each document. (See the Instructions for more information) <br /> VII. ATTACII114ENTS: Attachments are not required for Commercial Lartrdry facWtlu. <br /> ❑ 1. A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries- <br /> 0 2. A unit specific notification form for each unit to be covered at this location. <br /> DTSC 1772 (1/95) Page <br />