Instructions for "General Business Information Form" - California

This document was released by California Department of Toxic Substances Control and contains the most recent official instructions for General Business Information Form.

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Download Instructions for "General Business Information Form" - California

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Instructions for Completing General Business Information Form
BUSINESS INFORMATION
1. Business Name – Enter the name of the business, company or corporation for which this form is
being submitted.
2. Business Owner Name – Enter the name of the corporation or individual that has ownership or
control of the business which this form is being submitted.
3. Business Location & Telephone Number – Enter the street address and zip code of the business
and the city and county in which it is located. Enter the business telephone number and a facsimile
number, if available.
4. Business Contact Information – Enter the name, title, telephone number and e-mail address (if
applicable) of the individual who will be the business contact for participation in the Metal Finishing
Model Shop Program.
5. Mailing Address – Enter the mailing address for business if different than the address entered in
No. Include street address, city, zip code and county.
6. Type of Metal Finishing – List the type of metal finishing that the business currently engages in (i.e.
anodizing, chromium plating, nickel plating etc.)
7. Hazardous Wastestreams – List two to three of the largest hazardous wastestreams generated by
the business. Identify how these wastestreams are currently being handled (i.e. recycled, treated or
sent for disposal).
8. Business Participation - Describe what the business hopes to achieve by participating in the Metal
Finishing Model Shop Program. Check the boxes that apply. Identify other reasons which are not
listed. List the 2 most important items to the business.
REGULATORY INFORMATION
9. EPA Identification Number – Enter the hazardous waste identification number assigned to the
business by the U.S. Environmental Protection Agency or the Department of Toxic Substances Control.
This number typically begins with the letters CAD, CAL, CAR or CA. List all EPA ID numbers.
10. Inspections & Permits – Check all boxes which correspond to the agencies which have inspected
and/or issued a permit/authorization to the business. If you have received a permit from any of the
listed agencies, enter the corresponding permit number. Include the names of other agencies not listed
which have inspected the business and/or issued permit numbers. If you have entered into a Consent
Decree with the Department of Toxic Substances Control, circle “YES” if not circle “No”. Enter the date
the Consent Decree was signed by the business and the corresponding docket number. The docket
number is listed on the upper right half on the first page of the Consent Decree.
POLLUTION PREVENTION INFORMATION
11. Pollution Prevention Program – Circle Yes if the business currently has a pollution prevention
program. Circle No if it does not.
12. Describe the Pollution Prevention Program – Describe the pollution prevention program and/or
pollution prevention activities the business currently has in place. Please include hazardous waste
reduction efforts the business has made or is making. Check the boxes which describe any kind of
resource conservation that the business is doing.
13. If the Business Has No Pollution Prevention Program – Please describe the reasons which are
preventing the business from developing and implementing more pollution prevention activities (i.e. lack
of knowledge on alternative technologies, resource & funding limitations, etc.).
14. Specific Pollution Prevention Information Requested – Please identify any pollution prevention
information which you would like more information on.
15. Day & Time – Enter a day(s) and time(s) which are most favorable for the business contact to meet
with a DTSC representative to discuss participation in the Metal Finishing Model Shop Program.
16. Completed Form – Upon completion of this form, please submit this document to the individual
and address provided. Contact the Department of Toxic Substances Control at the telephone number
provided if you should have further questions about this form or require more information on the Metal
Finishing Model Shop Program.
Instructions for Completing General Business Information Form
BUSINESS INFORMATION
1. Business Name – Enter the name of the business, company or corporation for which this form is
being submitted.
2. Business Owner Name – Enter the name of the corporation or individual that has ownership or
control of the business which this form is being submitted.
3. Business Location & Telephone Number – Enter the street address and zip code of the business
and the city and county in which it is located. Enter the business telephone number and a facsimile
number, if available.
4. Business Contact Information – Enter the name, title, telephone number and e-mail address (if
applicable) of the individual who will be the business contact for participation in the Metal Finishing
Model Shop Program.
5. Mailing Address – Enter the mailing address for business if different than the address entered in
No. Include street address, city, zip code and county.
6. Type of Metal Finishing – List the type of metal finishing that the business currently engages in (i.e.
anodizing, chromium plating, nickel plating etc.)
7. Hazardous Wastestreams – List two to three of the largest hazardous wastestreams generated by
the business. Identify how these wastestreams are currently being handled (i.e. recycled, treated or
sent for disposal).
8. Business Participation - Describe what the business hopes to achieve by participating in the Metal
Finishing Model Shop Program. Check the boxes that apply. Identify other reasons which are not
listed. List the 2 most important items to the business.
REGULATORY INFORMATION
9. EPA Identification Number – Enter the hazardous waste identification number assigned to the
business by the U.S. Environmental Protection Agency or the Department of Toxic Substances Control.
This number typically begins with the letters CAD, CAL, CAR or CA. List all EPA ID numbers.
10. Inspections & Permits – Check all boxes which correspond to the agencies which have inspected
and/or issued a permit/authorization to the business. If you have received a permit from any of the
listed agencies, enter the corresponding permit number. Include the names of other agencies not listed
which have inspected the business and/or issued permit numbers. If you have entered into a Consent
Decree with the Department of Toxic Substances Control, circle “YES” if not circle “No”. Enter the date
the Consent Decree was signed by the business and the corresponding docket number. The docket
number is listed on the upper right half on the first page of the Consent Decree.
POLLUTION PREVENTION INFORMATION
11. Pollution Prevention Program – Circle Yes if the business currently has a pollution prevention
program. Circle No if it does not.
12. Describe the Pollution Prevention Program – Describe the pollution prevention program and/or
pollution prevention activities the business currently has in place. Please include hazardous waste
reduction efforts the business has made or is making. Check the boxes which describe any kind of
resource conservation that the business is doing.
13. If the Business Has No Pollution Prevention Program – Please describe the reasons which are
preventing the business from developing and implementing more pollution prevention activities (i.e. lack
of knowledge on alternative technologies, resource & funding limitations, etc.).
14. Specific Pollution Prevention Information Requested – Please identify any pollution prevention
information which you would like more information on.
15. Day & Time – Enter a day(s) and time(s) which are most favorable for the business contact to meet
with a DTSC representative to discuss participation in the Metal Finishing Model Shop Program.
16. Completed Form – Upon completion of this form, please submit this document to the individual
and address provided. Contact the Department of Toxic Substances Control at the telephone number
provided if you should have further questions about this form or require more information on the Metal
Finishing Model Shop Program.