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EPA ID NUMBER CAL000063116 Page 2 of <br /> -MAELING ADDRESS, rF DTFF'ERENT: <br /> COMPANY NAME (DBA) Delta Radiolnuy Medical rromn Tnc., <br /> STREET 1121 W. Vine St. , Suite 15 <br /> CITY Tnrli STATE _A ZIP 95240 - <br /> COUNTRY <br /> (oNy complete if rm USA) <br /> CONTACT PERSON Nita Kamt) PHONE NUMBER( 209) 369 -8261 <br /> (Fiat Name) _ (Lau Name) <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a jour digit number) (hat best describe your company's products, services, or industrial acrivin•. <br /> F-rample: 73&4 Phorofinishiny lab IM <br /> Printed circuit boards <br /> First: 8011 Radiology Office Second: <br /> IV. PRIOR PERMIT STATUS: Check yes 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 /> ❑ ® 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 /> ❑ ❑ 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 ENFORCENIENT HISTORY: Not required from generators only noting as condit1ona1Jy a empi. <br /> y r <br /> _ - <br /> YES 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 coF <br /> of the cover sheet from each document. (See the Instructions for more information) <br /> DTSC 1772 (1/93) Pace 2 <br />