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I <br /> EPAID NUMBER CAD 0091 .14 .J Page 2 of 'C <br /> \IAILEYG ADDRESS, IF DIFFERENT: <br /> " O,IPANY NAME (DBA) SAME <br /> STREET <br /> CITY STATE _ ZIP <br /> COUNTRY <br /> Body eomplem If not USA) <br /> CONTACT PERSON SAME PHONE NUMBER( <br /> (First Namei Blau Nemel <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> _'se either one or two SIC codes fa four digit number/ that best describe vour company's products, services, or industrial activity. <br /> Erampie: 7384 Photofinishing lab 3672 Printed circuit boards <br /> First: 2621 PAPER MILL Second: <br /> IV. PRI-OR PERMIT SrATUS: Check ves or no to each question: <br /> YES NO <br /> ❑ ® I. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? <br /> ❑ 0 _. 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 /> ❑ © 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 /> ❑ 0 3. 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 /> ❑ 0 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 r tafyfng as condirionalty ezonpt. <br /> SES NO <br /> ❑ ❑ 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) Paie 2 <br />