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i"of California-Cdifornu Fnriroor •al Protection Agency Departmmt of Tone Sulnpimm Controi <br /> Check Number "7 I of 15 <br /> 920407 <br /> fin{ A. <br /> HAZARDOUS .,r. <br /> ONSITE HAZARDOUS WASTE TREATMENT NOTIFICA�I� <br /> 1\_��R_ <br /> FACILITY SPECIFIC NOTIFICATION ENVI11-) 6i <br /> Y For Use by Hazardous Waste Generators Performing Treatment Initial <br /> v <br /> J Under Conditional Exemption and Conditional Authorization, ❑ Revised <br /> w, and by Permit By Rule Facilities <br /> C <br /> a <br /> h Please refer to the attached Instructions before completing this form. You may notify for more than one permitting tier by using this <br /> I nor fcaiion form, D7SC 1772. You must attach a separate unit specific notification form for each unit at this location. There are <br /> different unit speck notification forms for each of thefour categories and an additional notification form for transportable treatment <br /> units (7771s). You only have to submit forms for the tier(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 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 notification will not be considered complete without payment of the appropriate fee for each tier under which you are operating. <br /> (Please note that rhe fee is per 77ER not per UNIT. For example, if you operate 5 units but they are all Conditionally Authorized, <br /> you only owe $1,140, NOT 5 timer$1,140. V 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 on the check Fill in the check number in the box above. <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 Exm" Small Quantity Treatment operations may not opefate units under any other tier. <br /> Number of units and attached unit specific notifications Fee per Tier <br /> (not per unit) <br /> A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) $ lop <br /> B. _ Conditionally Exempt-Specified Wastestream (Form DTSC 1772B) $ 100 <br /> C. 2 Conditionally Authorized (Form DTSC 1772C) $1,140 <br /> D. Permit by Rule (Form DTSC 1772D) $1,140 <br /> Total Number of Units Total Fee Attached $ 1 ,140 <br /> II. GENERATOR IDENTIFICATION <br /> EPA ID NUMBER CA D 0 0 0 6 3 3 0 3 2 BOE NUMBER (if available) H Y HQ36 0 0 6 9 8 0 <br /> NAME (Company or Facility) ARCO Products Company <br /> (DBA—Doing Busiuew Aa) <br /> PHYSICAL LOCATION Stockton Terminal <br /> 2700 West Washington Street <br /> CITY Stockton CA ZIP 95203 For DTSC Use Only <br /> - <br /> Region <br /> COUNTY <br /> San Joaquin <br /> CONTACT PERSON James J. Szemes PHONE NUMBER(209 )466 - 4407 <br /> (Fire Name) (Lan Name) <br /> DTSC 1772 (1/93) Page I <br />