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FORM.12ZL-�W• e� <br /> A. PROBLEM IDFNT cATIm /J / <br /> Facility Name <br /> z. <br /> Second copy is <br /> Facility Speclfic Form: missing 3 4 (circle one) <br /> ❑ Revised box checked rte/ <br /> [3I. Notification Categories. As � . <br /> ❑ Tien marked do not match type of forms filed. <br /> ❑ / of forms attached do not match total /of units. <br /> ❑ Mer 'A' checked with other tiers. <br /> ❑ II. Generator Identification n <br /> ❑ EPA # incorrect/missing <br /> ❑ Name/Address incomplete <br /> ❑ Contact Person/Phone / missing <br /> ❑ ]]I- Type of Co.: Standard Industrial Clauification Code - missing <br /> ❑ VI. Attachments (missing): <br /> ❑ Certification(s) <br /> ❑ Plot Plan missing <br /> ❑ No signature/tide/date <br /> ❑ Questionable title <br /> ❑ No original signature on both copies <br /> Unit Specific Forms: <br /> ❑ Unit NamelUnit ID X - missing <br /> ❑ Number of Devices - no X (x is unacceptable) <br /> I. Wastestreams & Treatment Processes <br /> ❑ Total Volume Treated - no quantity <br /> ❑ ,Wastestreams - none marked <br /> ❑ Certified Technology - certification if missing <br /> ❑ II. Narrative Descriptions - Blank 1 2 3 <br /> ❑ M. Residual Management - r3 - letter not checked when Yes (others can be blank) <br /> ❑ N. Basis For Not Needing A Federal Permit - missing <br /> ❑ V. Transportable Treatment Unit - if marked, set aside for special handling <br /> Additional Comments/Problems: <br /> Reviewed by Date: j <br />