Laserfiche WebLink
STATE /PE >, a <br /> Malls Print or type with ELITE type(11 chencbrr per inch/in the unshaded areas only Form Approved OMB No.10500078 f+p,rea 93088 <br /> GSA No. 01 cBfPA 07 <br /> United Stat, <br /> tsl I EnvlronIn met Protection Agency Please ruler to the /nstrucfions /or <br /> Washington,DC 20460 Fi/inpp Nofiricetion lrelare tomplelingg <br /> this form.The Information requested <br /> 1 'Ift►EPA Notification of Hazardous Waste Activity 3010 or thhere Is °eRlesouce law Conservetio� <br /> 1 For Official Use only srMRecove Act/. <br /> Comments <br /> C <br /> Detr Received <br /> trtaullnlon i EPA 10 Number tived (yr- Re day/ <br /> F i <br /> . Name of Instsiletlon <br /> O R C RI A R D S U P P L Y IG A ' R D W' A R E <br /> 11. Installation Mallin Addreu <br /> Street or P.O. ■ <br /> P O d O X 4 9 0 2 7 FF <br /> C a T Stale LP Code <br /> -41 <br /> S A N J O S E 7 FTTT-FF-1-1- C' A 5 16 1 <br /> III. Location of Installation <br /> Street"Flouts Number <br /> 2 1 615 1 0 1 N I I MIA C A I R I T I H I U R D R I V E <br /> Cl or town Stets 21P Code <br /> T RIA C Y C I A 5 3 7 6 <br /> V. Installation Contact <br /> Name and Title /est Itri end ob title) a Number Lve,coda and number <br /> T 1 M E S P A' S A.. N D I N I I 1 4 0 8 1 3 6 1 5 1 2 6 1 8 2 <br /> wne I <br /> A.Name of Installation i I Owner S.T of Ownershi enter code <br /> O R C H A D S U P L Y H ll W R C ORP. P <br /> Ine of Regulated Wekte ActivityMark X'In the o 'at boxes. Refer to Instructions. <br /> A. Wash 9 - Os Fu.l Attivitlss <br /> a Osrterator• ❑ 1b.Lass dun 1Ap0 Wine. ❑ d Ory spsceiCNtlon Used 011 Fuel - <br /> L Trarnparmr. t ranter X'ad rtwi AtpropNats bo,ea bebw/ <br /> t-� /DisPeser `T/', t <br /> ..U11-•Y•rMt��ar/B,lWD�naf�yy���� �' / �:.�� ��'.•r ��Lial�Maldr tl�al�adr1a 11S dUrfMf <br /> ❑�N�YMY^ewpw .. fh. y4 r r1� i�1ti�3. . . <br /> •,- +,t,• r...lute; i �l t,.r �J .' 'CSI t,,,l. t•�A.tarlk�sf F <br /> bNlbl or Bum Nft�,tfbld 'r ! <br /> . Nr5er 7r ara/rnant rtanjpet.ta eau..Iwbat7 ' S r.•� ❑�?•st.n.r <br /> ` t❑a.brrnwtrta iVlertetfA�l ae dutnsr -LJ i Rlbn U60 On�ewl.Nlarkow for On,he eurnerl <br /> OtMr y+rehasw ` ' ' -.� Finl aslrM the 06 Mees the Specifimion <br /> ❑ starts} - >rl " �: - <br /> I.Waste Fuel Bumfnpilypsof CATbUsftn evltpl(VrrW7CMau0',ps+rgorlero boss#tolndiests type of combustion devicaf4in <br /> hazardous~V Amf m on-spsed/car/on used ail fuel/s aurnad-sae kremrcthro rot dwindlons ai corrtbusdon devices.! <br /> ❑A.UNI Boller ❑a.Irtdtlatri6l Bayer ❑ G fnth,uriol Furnace <br /> V_ill. Mode of Transportation frena iters onl —enter JC in the approodaire bo es <br /> ❑ A.Air ❑ B.Sell ❑ C.fflghway ❑ D.Water ❑ E.other txvcl/y/ <br /> IX. First or Suba uent Notification <br /> Mark X In the appropriate boor to indicate wMlher this Is your Installation's first notification of hazardous waste activity or a subsequent <br /> notification.If(his is not your first notification,anter your In"llattoni EPA 10 Number In the space provided below. <br /> G Installation's EPA ID Number <br /> First Notification 0 B.Subsaquem Notification(compiled harry Cl — <br />