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J:sl 01 99 03: 29p n DeAngelis 2' 468-4730 p. 6 <br /> .Iun 25 99 12:25p Dan DeAncelis 209-468-4730 P 1a <br /> Page 2 of <br /> EPA ID NUMBER__�---- <br /> III. RADIOACTIVE MATMALS OR WASTE <br /> YES NO <br /> Does the facility use, store or treat radioactive materials or radioactive waste? <br /> IV. TYPF.OF COMPANY: STANDARD LMDUSTRIAL CLASSIFICATION(SIC)CODE: <br /> Use either one or two SIC codes (a Jour digit number)rho,best describe your contpahy'r products,services, or indrurria1 acnyir> <br /> is ln�•sta 1at+nda= <br /> EzamOfr: 7384 pheMfirtlshlnr lab — — <br /> Second: <br /> First: .---- —Y---��— <br /> V. PRIOR PERMIT S!fATUS: check yes or no to tach qutstion. <br /> YF.S NO <br /> ® 1. Did you file a PBR Notice of IWAM to OPuate(DISC Form fl462)in 1992 for this location? <br /> 2. Do you cow ba.,at have yOU ever held a state or federal hazardous wast:factlisy full permit or interim <br /> status.rot aay of these tfeaxment units? of-U, <br /> 1. Do you now have or have you ever held a state or fedora[ full permit or interim status for any <br /> hazardous waste activities u this toeuion? <br /> a, have you ever held a variance issued by the Dtparcrnem of Toxic Substaoca Control for the treatment yo.� <br /> arc now notifying for at this locarioal <br /> 5, Has this location ever been[asPedcd by the state or any local agency as a hazardous waste generator' <br /> VI. PRIOR F-N ORCUMENT IOSTOM. Nor rtgaired fibs"eondlrbnally tztntpt ge"AUOrr or rormrriercial laundntt. <br /> y1:S NO J1ud rr'CMs,sctt[emesu$,or:ir ki <br /> EJ r� within the last three years, has this fuiilry turn the subject of any eonvictiotu,, g of public heath% <br /> orders lesulting from au action by any local, state, or fedetsl eavirtxtmcntal,hazardous waste, <br /> cnforument agency? <br /> (For the purposes of this form, a notice of violuion doer not constitute an order and need rwc be reported unless <br /> t was not corrected and becmc a final otder.) <br /> If VOtl ln$Wered Yes,check th'tsbox andatcaeA all$ting Df oonvtcuo:u„udgrnenis.seinen+uxa,oc ocden and Cow. <br /> Of' <br /> the cover slices from esch docvwent.(Set the lnsuuctions for more iaforma,ion:I <br /> Vil. ATTACIIMENTS: Attachrntats are not required front co"freial laundries. <br /> I A plot piantmap detailing the iocauon(s)of the coverilsty boundaries <br /> ed unit($►in relation to the fac <br /> A units spocifto notification f,)nn for each unit to be coveted at this location. <br /> Pagc. <br />