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STATE / PERMANE <br /> Please Prim or lice win ELITE Iyeen3[hiiatte[s pas m[ ireaSonly aFa%m App <br /> 0M9 NO IO500O29.E—c 9.3.as. <br /> I tins hadM r I GSA No.0246-EPA-Or <br /> United States nvironma til Pr tecucn Agency Feax <br /> Please rater to the/snuaions lw <br /> Washington,OC 20460 Fiing No y o afion before completing <br /> A this o(m.Thein(Prmetio^rep coed <br /> Dere Is requires by law (Sactiora <br /> PQ Notification of Hazardous Waste Activity 3010 of. �Gon <br /> For Offtial Use Only <br /> •rq BeroyeryAW. <br /> Comments <br /> TELETEIT, I I <br /> - . -___•m a—h.ir Diner Received <br /> ' <br /> AApproaed M me. davl <br /> P V 98-241-5804 1 R i9d <br /> 1. Name of Installation <br /> D 1 C 1 P I A I C 1 O a I N CI . I I I I I I I I I I 1 I <br /> II. Installation Mallina Address <br /> Street pr P.O.Box <br /> 31 4 1 5 1 4 1 5 I A NIT AI S L IA IN 1E <br /> C or Tow^ State <br /> a ZIP Code <br /> S T O C KIT O � N � I I t i CSA 9 5 <br /> III. Location of installation <br /> Street or Harte Number <br /> 5 41514 1 5 1 1 Q A Pl T Al S L A N E <br /> Ci or Town $we LP Code <br /> S T I O C K T O I N I I I C A 9 5 2 0 6 U <br /> IV. Installation Contact Sy _I <br /> Name and Tine /aa.first and' b file Phone Number area rode arM number <br /> LIAIBIEILILIE12 C Ll I F FI 01 RI D P. C. 2 0 9 9 1 8 1 3 1 9 1 3 1 0 <br /> V. Ownershi <br /> A.Name of Installation's .10 wner 8.T e pf Ownershi entercode <br /> fl EID IW IA I RID IP.I FI IN TI TI S: I I p <br /> VI.TYPE, of Regulated Waste Activity Mark'X'in thea o riate boxes. Refer to instructions. <br /> A.Hazardous Waste Activist B.Used Oil Wel Activities <br /> 10 la.Generator C1 1b.Less than 1,000 kg/mo. 136.OR-Specification Used Oil Fuel <br /> ❑ 2 T;snsponi I tenter X'and mark eppropriare boxes below) <br /> 0 3.Treater/Storer/Disposer ❑ a.Generator Marketing to Burner <br /> ❑ 4.Underground Injection ❑ b.Omer Marketer j�j�� �t' <br /> ❑ <br /> S.Market or Burn Hazardous Waste Fuel C I <br /> (enter W and mark appropriate boxes below) � Elrn <br /> c.Buer /// ��a <br /> C3a.Generator Marketing to Burner C1T.Specification Used Oil Fuel Marketer fp n/-0 sde 8.tj i <br /> ❑ D.Other Marketer Who First Claims the Oil Meets the Specification <br /> 0 c.Burner <br /> VII.Waste Fuel Burning:Type of Combustion Device(enfer'X'in a/lappropriareboxes mindicale rypeo/combustion donco I)in <br /> which hazardous waste fuel or oO-specby afion used oil rng is burned.Ses instructions/w definitions of combustion devices./ <br /> 0 A.Utility hailer ❑ B.Industrial Roiler 0 C Industrial Furnace <br /> VIII. Mode of Transportation iltransporters,only—enter Xin the app,ria box es <br /> 0 A.Air 1:18 Rau 1Z C.Highway ❑ o.Water ❑ E.Omer tape ars <br /> IX. First or Subsequent Notification <br /> Mark 'X' in the appropnare box to indicate whether this is your installation's first rundication of hazardous waste actwily or a subsequent <br /> notification.It this is not your first notification,enter your installation's EPA ID Number in me space provided below. <br /> C.Installation s EPA 10 Number <br /> Q A.First Notification 0 B.Subsequent Notification(complete item C/ I I 1 <br /> EPA Form 8700.12(Rev. 11-85)Previous ednmn,s obsoole Continue on reverse <br />