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State of California-California Fmrunomen4 necOoo Agesry Department of Toric Substances Control <br /> Page 1 of 6 <br /> ONSITE HAZARDOUS-WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> OcUse:by--U�ffdous Waste Generators Performing Treatment ® Initial <br /> Under Conditional Exemption and Conditional Authorization, ❑ Renewal <br /> and by Permit By Rule Facilities ❑ Revision <br /> Please refer to the attached Instructions before completing this farm. You may notify for more than one permitting tier by using this <br /> ratification form, D7SC 1772. You must attach a separate unit specific notification form for each unit at this location. There are <br /> different unit specific not ficationforrm for each of the four categories and an additional notification form for transportable treatment <br /> units (771I's). You only have to submit forms for the tier(s) that cover your unit(s). Discard or recycle the other unused farms. <br /> Number each page of your completed notification package and indicate the total number of pages at the top of each page at the <br /> Page — of_'. Put your EPA ID Number on each page. Please provide all of the information requested; all fields must be <br /> completed except those that state 'if different' or 'if available'. Please We the information provided on this form and any <br /> attachments. <br /> The ratification fees are assessed on the basis of the number of tiers the notifier will operate under, and will be collected by the State <br /> Board of Equalization. DO NOT SE711D YOUR FEE FflM 77HS NO77IC177ON FORAL <br /> I. NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit specific notification forms you must attach. <br /> Conditionally Ezonpt Small Quaraity treatment operations may not operate units under any other tier. <br /> Number of units and attach emit specific notifications for each tier reported. <br /> A. Conditionally Exempt-Small Quantity Treatment D. Permit by Rule <br /> B. 1 Conditionally Exempt-Specified Wastestream E. Commercial Laundry <br /> C. Conditionally Authorized F. Variance (Section 25205.7) <br /> II. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CAD 0 0 9 1 4 0 1 2 0BOE NUMBER (if available) H AHQ 3 1 L L6 9 3 5 <br /> _ <br /> _ <br /> FACILITY NAME MARLEY COOLING TOWER COMPANY <br /> (DBA—Doing Businew As) <br /> PHYSICAL LOCATION 150 N SINCLAIR AVE <br /> CITY STOCKTON CA ZIP 95215 <br /> COUNTY SA1I JOAQUIN <br /> CONTACT PERSON DAVID LIEB PHONE NUMBER( 209) 465-3451 <br /> (Firm Name) (Lan Name) <br /> MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME <br /> STREET <br /> CITY STATE _ ZIP <br /> COUNTRY <br /> (only complete if oat USA) <br /> CONTACT PERSON PHONE NUMBER(_ <br /> (Firm Name) (Lam Name) <br /> DTSC 1772 (7/94) <br /> Page 1 <br />