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i EPA ID NUMBER CAL' X063115 Page 2 of 3 <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME (DBA) Delta Radiology Medical Group Inc <br /> t <br /> STREET 1121 W. Vine St. Suite 15 <br /> CITY Ledi STATE -.Ca- ZIP 95240 <br /> COUNTRY <br /> (ody complete if na USA) <br /> CONTACT PERSON Nita Kei PHONE NUMBER( 209) 369 -8261 <br /> (Firu Name) . (Lu Name) <br /> in. TYPE OF COMPANY: STANDARD INDUSTRIAL, CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a jour digit number) that best describe your company's products, services, or industrial activity. <br /> Fkample: 7384 PhoroRnfshinr lab3672 <br /> Printed circuit boards <br /> First: Rn1L Rad;Q1QCA7 nff; Second: <br /> IV. PRIOR PERMIT STATUS: Check yes or no to each question: <br /> ITS NO <br /> ❑ ® 1. Did you file a PBR Notice of Intent to Operate (DTSC 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 /> I1----11 status for any of these treatment units? <br /> ❑ t p 3. Do you now have or have you ever held a state or federal full permit or interim status 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 you <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 /> V. PRIOR ENFORCEMENT HISTORY: Not required from generators only naloing as conditionally ezen9K. <br /> YES NO <br /> ❑ ❑ Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final <br /> orders resulting from an action by any local, state, or federal environmental, hazardous waste, or public health <br /> en(oecemeot agency? <br /> (For the purposes of this form, a notice of violation does not constitute an order and need not be reported unless <br /> it was not corrected and became a final order.) <br /> ❑ if you answered Yes, check this box and attach a listing of convictions,judgments, settlements, or orders and a cof <br /> of the cover sheet from each document. (See the Instructions for more information) <br /> DTSC 1772 (1/93) Page 2 <br />