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Stale of California •California Envl Cental Protection Agency Department of Toxic Substances Control <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> EONSITEAZARDOUS WASTE TREATMENT NOTIFICATION — FACILITY PAGE <br /> i <br /> Page of <br /> BUSINESS NAMERamaa.FACu.trYNAArnw ODA Do,.eawuner An t FACILITY IDM <br /> Silicon Turnkey Solutions <br /> H. STATUS <br /> NOTIFICATION STATUS A00 PERMIT STATUS(Check all that apply) du <br /> Q a Amended Qa Facility Permit ❑d Variance <br /> ❑b Initial ❑b Interim Status ❑e Consent.Agreement <br /> ❑c Renewal(PBR Only) ❑c Standardized Permit <br /> III. NUMBER OF UNITS AT FACILITY <br /> (Indicate the number of unity you operate in each tier,amach one unit notification page for each unit except CE{U <br /> A Conditionally Exempt—Small Quantity Treatment(CESQT)(May not function under any other tier) <br /> B Conditionally Exempt Specified Wastestream(CESW) <br /> C Conditionally Authorized(CA) <br /> D Permit by Rule(PBR) i <br /> E Conditionally Exempt—Limited(CEL) <br /> F Conditionally Exempt Commercial Laundry(CE-CL) (No wit page is required for laundries) <br /> G TOTAL UNITS(Must equal the number of unit notification pages attached plus the number of CELL units) <br /> IV. CERTIFICATION AND SIGNATURE <br /> este Minimization I certify that 1 have a program in place to reduce the volume,quantity and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and <br /> future threat to human health and the environment- <br /> Tiered Permitting Certification I certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and <br /> regulations for the indicated permining tier,including generator and secondary containment requirements. 1 certify under penalty of law that this document and all <br /> attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the <br /> information submitted. Based on my inquiry of the person or persons who manage the system,or those directly responsible for gathering the information,the <br /> information is.to the best of my knowledge and belief.true,accurate,and complete. <br /> 1 am aware that there are substantial penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations. <br /> SIGNATRE ER/ ERAT R DATE eon <br /> �a 5. �tst�1 <br /> NAME OF UWpEK/UPERATOR TITLE OF OWNER(OPERATOR cos <br /> Zef Malik President <br /> REQUEST FOR SHORTENED REVIEW PERIOD(CE and CA only) ❑ Yes ❑ No <br /> State Reason for Request <br /> V.ATTACHMENTS(Check if attached) <br /> ALL tiers except CELL(Laundries)must submit: PBR ONLY <br /> ❑ 1 One unit specific notification page and one treatment pmcess page per unit ❑ I Tank and container certifications.if required <br /> ❑ 2 Plot Plan(or other grid/map) ❑ 2 Notification of local agency or agencies <br /> ❑ 3 Notification of property owner,if different from business owner <br /> P13R K CA ONLY. <br /> [� I Closure Financial Assurance(formerly DTSC form 1232) <br /> (a Scif Cenitied(<310.000) ❑ Other mechanism <br /> ❑ 2 Prior Entbrcemcm History,if applicable <br /> UPCF(1/99 revised) 20 Formerly DTSC 1772 <br />