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State of Caafo`ma-California Environmental P 'ection Agency Department of Toric Substances Contavl <br /> TRANSPORTABLE TREATMENT UNIT PERMIT BY RULE <br /> SITE-SPECIFIC NOTIFICATION <br /> For Use by Transportable Treatment Unit(TTU) <br /> Treating Hazardous Waste Under Permit By Rule Initial <br /> (Pursuant to CCR,title 22„chapter 45) <br /> ❑ Amended <br /> ❑ Extension <br /> Thu form is to be used by all Permit-by-Rule(PBR) Transportable Treatment Units(TTUs)only. This Transportable Treatment <br /> Unit Permit-11kRule,Site-Specific Notification supersedes DTSC Form 8429A. When submitting an amended nohTwafion,put an <br /> asterisk next to the amended information. Please check the extension box only if you are requesting authorization for work beyond <br /> the one year time limit The wastestreams treated must be limited to those fisted in California Code of Regulations(CCR),tide 22, <br /> section 67450.11,which are also fisted on this form. <br /> L GENERAL TTU INFORMATION <br /> COMPANY EPA ED NUMBER CA_k Q Qo -a L 2–a�Z <br /> BOE NUMBER (if available)H 6 0 6 C) q'2-3 TTU SERIAL NUMBER )t 3 0 u 0 2- <br /> COMPANY NAME (DBA-Doing Business As) G li M 04.eb (a. 'Tfe—+rv� i•v��� A- <br /> PHYSICAL LOCATION 1116 y V -- ) S+�h <br /> CITY CAZIP 0755 <br /> COUNTY LAS �nL�SS <br /> COMPANY MAILING ADDRESS,IF DIFFERENT: <br /> STREET <br /> CITY STATE ZIP <br /> OWNER Pa� &,Jarx,— <br /> OWNER PHONE NUMBER( L-z <br /> TTU OPERATOR INFORMATION,ONLY IF DIFFERENT FROM OWNER <br /> OPERATOR NAME <br /> STREET <br /> CITY STATE ZIP <br /> OPERATOR PHONE NUMBER csmn 1 43 G- 1 f 4 S <br /> TTU CONTACT PERSON 9- ls.s PHONE NUMBER <br /> first name) (last name) <br />