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EPA ID ,'SlU'MBER C-7tD980893i 8d_ Page 2 of-1-9 <br /> NiALLNG ADDRESS, IF DIFFERE'SM <br /> COMPAN-Y JNAME (DBA) <br /> STREE7 <br /> CITY STATE ZIP - <br /> COUNTRY <br /> (only complete if not USA) <br /> CONTACT' PERSON PHONE NUMBERL__) - <br /> (First Name) (Last Name) <br /> III, TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or wo SIC codes (a four digit number) that best describe your company's products, services, or industrial activity. <br /> Example 7384 Photofinishing lab 3672 Printed circuit boards <br /> First: 3672 Printed Circuit Boards Second: <br /> TV, PRIOR PERMIT STATUS: Check yes or no to each question: <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 /> status for any of these treatment units? <br /> ❑ U 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 /> El ❑ 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 notifying as conditionally erempt. <br /> YES N0 <br /> ❑ 10 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 /> enforcement 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 copy <br /> of the cover sheet from each document. (See the Instructions for more information) <br /> DTSC 1772 (1/93) Page 2 <br />