Laserfiche WebLink
-State of Calilorma i'rvt6tm Aatocr <br /> Depa+>mmt of Toric auLaao® l.:aalrt <br /> Page t cr _ <br /> 'V ONSITE IiAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> r <br /> SEP <br /> = � FACILSIY SPECIFIC NOTIFICATION 8, 'S <br /> 1995 ! For Use by Hazardous Waste Gmerwors Performing Treatment - <br /> A ' Ander Condidonai Ezemotron and Comditionai Autborizauoa, u R=CvAi <br /> and by Permit By Rule Faduua ❑ Aamesrs <br /> 1 Please refer ro the anaehed lnurmaionr before compietine this form. You may notify jor more than one perk»thing tier by sting the <br /> nottftearton farm, =1772. You must arraeh a separate unit specific norificuton form for each unit ar this locarton. There m <br /> different untt specific notification forms for each of the four mtegoner and an additional notifiearion form for rransporranle treamm- <br /> unus (='s). You only have to submit forms for the tier(r) that cover your unit(s). Discard or rec'vcie the other unused ed jor <br /> Number each page of your compiard notification package and indicate the total number of pager at the top of eatyt page ar the <br /> 'Page _ of_'. Put your EPA LD Number on each page. Please provide all of the information requested. all fields must t <br /> curnpieted except those that nate 'if different' or 'if avauab/e'. Please type the information provided on this forst arta 4-- <br /> attachments.attachments. <br /> The notification fees are assessed on the basis of the number of tiers the notifser wail operate undo, and will be collected by the Stn <br /> Board of£quauzarion. DO NOT WW YOUR FEE Weil•=NOM47A77ON FORM <br /> L NOTIFICATION CATEGORIES <br /> lndinate the number of units you operate in each tier. This will also be the number of unit spectftc notification forms you Past ars <br /> Cowduio^ady Fsnanpt Small Quantity Trr=mm operations may not operme toots under a"aother tier. <br /> Number of units and attached unit specific notifications for each tier reported. <br /> A. Conditionally Ezempt-StnaB Quantity Treatment D. Pamir by Rule <br /> B. X;K Coaditionally Exempt-Specified Wtstesuum ✓ E. Commercial Laundry <br /> C. Conditionally Authorized G I qts F. Variance (Section 35705.7) <br /> 11. GENERATOR IDENTIFICATION I I <br /> EPA 1D NUMBER CA L923424282 BOE NUMBER (ifavwlable) H_HQSY OHQ <br /> FACILITY NAME Wal-Mart One Hour Photo #1840 <br /> (URA—Doing Boaiacu Ail <br /> PHYSICAL LOCATION 1205 South Main Street <br /> CITY Manteca CA ZIP95336 - <br /> COUNTY San Joaquin <br /> CONTACT PERSON Shawna Naaamine PHONE NUMBER( 209) f374 -_2_j L <br /> (Fina Namc) (Laa Namc) <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME Saxe as a*,,ove <br /> Fa DISC l=u� <br /> STREET Ragan_ <br /> CITY STATE ZIP <br /> COUNTRY <br /> 1Ws40MP t i(mtUSA) <br /> CONTACT PERSON PHONE NUMBER(___)_ <br /> (Fari Nuoe) (Lam Narnet <br /> Pagt <br /> DTSC 1772 (1195) <br />