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;tate of California- California Environmental I otection Agency Q�/I �r/� Department of Toxic Substances Control <br /> Page 1 of 9 <br /> ONSITE HAZARDOUS WASTE ,TREATv1ENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION ® Initial <br /> For Use by Hazardous Waste Generators Perforating Treatment ❑ Amended <br /> Under Conditional Eaemotioo at{ft*d4ignal Authorization, <br /> and by Permit By Rule Facilities <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. DTSC 1772. You must attach a separate unit specific notification form for each unit at this location. There are <br /> different unit specific notification forms forfive of the categories and an additional notification form for transportable treatment units <br /> (7TU's). You only have to submit forms for the tier(s)/caregory(tes) that cover your unit(s). Discard or recycle the other unused <br /> forms. Number each page of your completed notification package and indicate the total number of pages at the top of each page at <br /> the 'Page_ of_'. Put your EPA ID 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 fees are assessed on the basis of the highest der the norifier will operate under and will be collected by the State <br /> Board of Equalization. DO NOT SEND YOUR FEE PAYMENT WITH THIS NOTIFICATION FORM. <br /> I. NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit specific notification forms you <br /> must attach. Conditionally Exempt Small Quantity Treatment operators may not operate units under any other tier. <br /> Number of units and attached unit specific notifications for each tier reported. <br /> A. 0 Conditionally Exempt-Small Quantity Treatment (CESQT) D. 1 Permit by Rule(PBR) <br /> B. Conditionally Exempt-Specified Wastestream (CESW) E. 0 CE—Commercial Laundry (CE-CL) <br /> C. Conditionally Authorized (CA) F. 0 Conditionally Exempt-Limited (CEL) <br /> R. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CAT 0 0 0 b-4-SL L_B 2 BOE NUMBER (if available) HLHQ 3 6 k Q Ai 3.L 2- <br /> FACILITY <br /> FACILITY NAME ISE Labs Inc AggemhJy np_nti <br /> (DBA—Doing Business As) <br /> PHYSICAL LOCATION 400 Industrial Park Drive <br /> CITY 'Manteca CA ZIP 95337 <br /> COUNTY San Joaquin <br /> CONTACT PERSON Gary Hubble PHONE NUMBER(2Q9 999 9239— <br /> (First Name) (last Name) <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME <br /> STREET <br /> CITY STATE _ ZIP <br /> COUNTRY <br /> (only complete if roc USA) <br /> CONTACT PERSON PHONE NUMBER(_) - <br /> (Fint Name) (Last Name) - <br /> Page i <br /> DTSC 1772 (1/96) <br />