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NOTIFICATION OF "SILVER-ONLY" HAZARDOUS WASTE TREATMENT FORM <br /> Company Name LL t rxc-C:,� Nnrrct:Grc: Company EPA ID Number CAP I $ L3a17 1_13L <br /> Company Address (Mailing) (tr i: 'T vrzuGTZ Qa <br /> City LL U i CA Zip Code `fb-?`fJ <br /> e ' i ' �J <br /> LM <br /> Unit Name RfSC ��Va� Unit ID Number <br /> L7 X10 7' <br /> Is your company eligible for the exemptions noted on page 1? YES_ NO_ <br /> If no, then disregard this notice. <br /> If yes, then please check the applicable wastestream box: <br /> The recovery of silver from photofmishing/photoimaging solutions and photoimaging solution wastewaters <br /> (provided that the solutions and wastewaters are "silver-only" hazardous wastes, and are not hazardous for <br /> any other reason or constituent). <br /> 1. Wastestream N 2 under CESQT(DTSC 1772B) -- if applicable. <br /> ❑ 2. Wastestream X 7 under CESW (DTSC 1772B). <br /> ❑ 3. Wastestream R 10 under CA (DTSC 1772B). <br /> ❑ a Wastestream N 2 under PRA (DTSC 1772B) -- if applicable. <br /> Are you authorized for any other treatment activity? YES_ NO_ <br /> If yes, under which tier are you author'id? <br /> CESW_CESQT_CA ✓ PBR_STD. PERMIT_FULL PERMIT_ <br /> Of your estimated monthly total volume of wastes treated, what portion is "silver-only" hazardous photofinishing <br /> wastes treated to recover silver? ! I `/e- (If this "silver-only" hazardous photofinishing portion is a significant <br /> portion of your total wastes treated, you may be eligible for regulation under a lower permit tier. Please contact your <br /> local CUPA to determine or confirm your regulatory tier status.) <br /> 1 certify under penalty of law that this document was prepared under my direction or supervision and the information <br /> is, to the best of my knowledge and belief, true, accurate, and complete. <br /> T'". <br /> Name (Print or Type) Signature Title Date <br /> Please submit the completed notification form to your local CUPA and also send a copy to: <br /> Department of Toxic Substances Control <br /> Unified Program Section <br /> P.O. Box 806 <br /> Sacramento, CA 95812-0806 <br />