Laserfiche WebLink
EPA ID NUMBEROA)��� ���D aJ ( Page 2 of <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME (DBA) <br /> STREET ' <br /> CITY STATE _ ZIP <br /> COUNTRY <br /> (only complete if not USA) -� <br /> CONTACT PERSON � ' a PHONE NUMBER1�"j� <br /> (Fru Name) (ta/Fi e) <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a four digit number) that best describe your company's products, services, or industrial acttviry. <br /> Example: 7384 Photofinishing lab 3671 Printed circuit boards <br /> First: �� %6&K6 I Lz`6 AA^)q(I Jfrond: <br /> IV. PRIOR PERMIT STATUS: Check yes or no to each question: <br /> YES NO <br /> ® ❑ 1. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? <br /> ❑ ❑ 2. Do Cu 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 /> ❑ ® 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 /> ❑ 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 froth generators only notifying as conditionally exempt. <br /> YES NppO�� <br /> ❑ 1L`k 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 />