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Plaase print or type with ELITE type (12 characters per Inch) in the unshaded areas only Fo Aono °Me No.20e 4028eawee ro-n-w, <br /> A No.0246-EPA- t <br /> Please refer to the aistrucfionsNotification of Date Received <br /> for Ahng Noiffkation before 'h (For Official Vse Only) <br /> ownplaton eform. The <br /> Information <br /> requested hem is EPA Regulated Waste <br /> reTared by law(Sectipn 3010 Activity <br /> � 'V qty <br /> of the Resource Consarvafion AC{l l <br /> and Recowrry Aa). United States Environmental Protection Agency <br /> 1. Installation's EPA id Number(Mark 'X'.)n the appropriate box) <br /> A. First Notification ❑ B.Subsequent Nottflcallon <br /> C. Installation's EPA ID Number <br /> (compreto item c) D CU G G Co c �/ J <br /> It. Name of Installation(include company and specNfc ahe name) <br /> 0 1 Ric II A IR-ID I S U P P L I Y I 1 H 1 A I R D I W I AIR I E <br /> III. Location of installation (Physical address not P.O. Box or Route Number) <br /> Street <br /> 2 6 5 0 N M I A I C I A R T H (J I R I I-Dj R I I I V I E <br /> Street continued <br /> City or Town #Statep Code <br /> R A CY 5 3 7 1 6 - <br /> Ceunty Code Count - Name <br /> S A I N I I J 0 <br /> IV. Installation Melling Address(See lnstructlona) <br /> Street or P.O, Box <br /> P 0 d O X 1 4 <br /> City or Town State ZIP Code <br /> S I AIN I I J 0 I S E I I I I I I I I I I I C A 915 1 6 11 1 - <br /> V. Installation Contact(Persort'Id be contacted regarding waste activities at <br /> Name last first <br /> Ii IJ E R J E I R I R I Y <br /> Job Tttie-+. Phone Number(area code and number) <br /> O PIE I RIA T I 10 -IN IS I IN IG 1R 2 0 9 - 8 3 3 - 3 1 1 4 <br /> Vl, Installation Contact Address(See fn_nrucuons) <br /> ontact ddress B. Sheet ar P,O. 6ox <br /> Locatlort s',MilNny <br /> xx 2 6 5 0 N I I M I A I C I AlRI T H U R I I D R I [IV I E <br /> City or Town r State I ZIP Code - <br /> 'I' R I A I C I Y I I I I I I CIA 9 5 3 7 1 6 - <br /> VII. Ownership(See Instructions) <br /> A. Name of Installation's Legal Owner <br /> U R C II AIR H A R D W A R E <br /> Street, P.O. 6ox, or Route Number <br /> I' 0 (3 O X 1 4 9 0 2 <br /> City or Town State ZIP Code <br /> SIA N I J 0 1 S E <br /> B,lend Type C.Owner Type D.Change of Owner (Date Changed) <br /> Phone Number area Coda and number Indicator Month Da Year <br /> z' 0 8 - 3 1 6 1 5 1 1 2 1 6 1 8 x Yes 0 <br /> No <br />