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NOTIFICaaTION OF ^SILVER-ONLY" aa-ZARBQUS• WASE TREATXNT FORM <br /> f� Ln C- <br /> rCompany Name GL'72J,y n� l � A`/65Co�mpaay EPA ID Number C2 _____ <br /> Company Address (Mailing) jj:j /xGf�/C/7vb� s1Ls �7 -7-7 <br /> City 3ra `lGTv t/ CA Zip Code fn Z-0 <br /> Unit Name &jZ ,j�zVUmt ID Number <br /> Is your company eligible for the exemptions noted on page I? YES�/ NO_ <br /> If no, then disregard this notice. <br /> If yes, then please check the applicable wastesueam box: <br /> The recovery of silver from photofmishing/phorminaging solutions and phamimagmg solution wastewaters <br /> (provided Char the solutions and wastewaters are 'salver-only" hazardous wastes, and are not hazardous for <br /> any other reason or constimcrr:)_ <br /> ❑ 1. Wasteshram S 2 under CESQT(DISC 17728) —if applicable. <br /> n ? Wasttstream 4 7 ander CESW(DISC 1772M. <br /> ❑ 3. Wastasheam Ir 10 under CA UMC 1772B). <br /> ❑ 4. W«tesr..em 4 2 md=-PBR FISC 1772B) —if applicable. <br /> Are you authorized for any other treatment activity? YFS_ NOX—/ <br /> If yes, under which tier are you authorized? <br /> CESW_CESQT_CA_PBR_M. PERMIT_FULL PERMIT_ <br /> Of your estimated monthly total volume of wastes [reared, what portion is 'silver-only" hazardous phomfinishing <br /> wastes treated to recover silver? (If this 'silver-only"hazardous phoroffiishing portion is a significant <br /> portion of your toml wastes treated,you may be eligible for regulation under a lower permit tier_ Pie=comact your <br /> local CUPA to determine or confirm your egtd=ry tier starts. <br /> I certify under penalty of law that this docamem was prepaed under my du==or supervision and the information <br /> is, to the best off my knowledge and belief, nue, accurate, and complete. <br /> Name (Print or Type) Si n Title Ddte <br /> Please submit the comalaed norifrcation forme to your land CUPA and also send a copy to. <br /> CUPA <br /> Deparrmm of Toxic Subsrarn Carmol San Joaquin County Environmental Health Div <br /> Unified Progrmn Section 304 E Weber Ave <br /> P.O. Box 806 Stockton CA 95202 <br /> Saamnerao, C1 95812.0806 <br />