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I Slate of California-Califotala Eariroonat V teetlor Agony ! _ Depari:oml or Task Substances Control <br /> Id <br /> Choc umber ..:. Be 1o13 <br /> qa -oova � <br /> IU <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM <br /> FACILITY SPECIFIC NOTIFICATION <br /> - For Use by Hazardous Waste Generators Performing Treatment ® Initial <br /> Under Conditional Exemption and Conditional Authorization, ❑ Revised <br /> and by Permit By Rule Facilities <br /> d <br /> 17 Please refer to the attached Instructions before completing this form. You may notify for more than one permitting tier by using this <br /> notification form, DISC 1772. You must attach a separate writ specific notfcation form for each writ at this location. 7here are <br /> different unit specific notificationformr for each of thefour categories and an additional not fcationform for transportable treatment <br /> units (77'U's). You only have to submit forms for the der(s) that cover your unit(s). Discard or recycle the other unused forms. <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 Ilformation requested; nil fields roust be <br /> completed except those that state 'if different' or 'if available'. Please type the Information provided on this form and any <br /> attachments. <br /> The notfcation will not be considered complete without payment of the appropriate fee for each tier under which you are operating. <br /> (Please mote that rhe fee Is per 77ER not per UNIT. For example, if you operate S writs but they are all Conditionally Authorized, <br /> you only owe $/,140, NOTS times$1,140. If you operate any Permit by Rule units and any units under Conditional Authorization <br /> you owe$2,280.) Checks should be made payable to the Department of Toxic Substances Control and be stapled to the top of this <br /> form. Please write your EPA ID Number ort the check. Fill In the check number in the box above. <br /> 1, NOTIFICATION CATEGORIES <br /> Indicate the number of units you operate in each tier. This will also be the number of unit specific notificationforms you must attach. <br /> Conditionally Exempt Small Quantity Treatment operation,may not operate units under any other tier. <br /> Number of units and attached unit specific notifications Fee per Tier <br /> + (nm per wrq <br /> A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ t00 <br /> B. 5 Conditionally Exempt-Specified Wastestream (Form D&eHQ <br /> u b s t e $ 100 <br /> anto aCCoC. Conditionally Authorized (Form DFwd51,140 <br /> D. Permit by Rule (Form Dm $1,140 <br /> 5Total Number of Unita ��' hed $ 100 <br /> +, � v,II. GENERATORJDENTIFICATIONEPA ID NUMBER CA L 0 0 0 0 2 2 6 9' 3 BOB NUMa _HQ 3 8 0 0 1 9 5 8 <br /> NAME (Company or Facility) California Cedar Products <br /> (DBA-Doing Business As) <br /> PHYSICAL LOCATION 1340 W. Washington Street <br /> For DTSCnUmonly <br /> CITY Stockton CA ZIp95203 1_ 3138 <br /> Region <br /> COUNTY San Joaquin <br /> CONTACT PERSONRod Gonzalez PHONE NUMBER 2( 09 ) 944 .5800 <br /> + (First Name) (Last Name) <br /> DTSC 1772 (1193) Page I <br />