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EPA ID NUMBER CAT 000646182 <br /> � Page9 of 9 <br /> PERMIT BY RULE <br /> UNIT SPECIFIC NOTIFICATION <br /> For Fixed Treatment Units Only <br /> (pursuant to Title 22, California Code of Regulations, Chapter 45) <br /> V. UNIT OWNER INFORMATION, ONLY IF DQG'FERENT FROM GENERATOR <br /> OWNER NAME N/A <br /> STREET <br /> CITY STATE ZIP <br /> — - COUNTRY <br /> CONTACT PERSON (oNy complete if not USA) <br /> (fm name) PHONE NUMBER(_) <br /> Out mme) <br /> VI. ATTACHMENTS: <br /> A. A certifications Specifying Eying the local agencies that have been notified of the operation. (Manda[ory) <br /> ❑ j- <br /> B. Documentation that the facility operator has notified the property owner of the operation of the unit. <br /> (Required only when the property owner is different from the generator/operator.) <br /> ® Check this box if the generator is also the property owner. <br /> © C A brief description of how the treatment unit operates (i.e., continuous, batch, intermittent, etc.). <br /> The manufacturer's operation specification sheet can be used to saris <br /> fy this requirement. (Mandatory) <br /> F D The tank and/or container containment system certifications. Required by Title 22, CCR, Section 66264.175(c)for <br /> containers and by Sections 66265.191(a)and 66265.192(a)for tanks. (Mandatory, although the <br /> depends on the type of treatment unit, either tank or container.) / type of certification <br /> 0 E. Phase I Environmental Assessment Checklist must be submitted by January 1, 1997, or within one year of the daze <br /> when you are initially authorized to operate, whichever date is later. permit by Rule facilities are authorized when <br /> DTSC issues your authorization letter. <br /> D F. Financial Assurance for Closure must be provided on or before October 1, 1996, using DTSC Form 8113 (1/96). <br /> NOTE: PBR facilities are no longer required to provide a financial responsibility mechanism to cover third party <br /> liability costs, per Senate Bill 1291 (Chapter 640, Statutes of 1995). <br /> DTSC 1772D (1/96) <br /> Page 23 <br />