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FQBM 1M—r "JRTEgY REFVrFw pROitT-M c�+ <br /> A. PROBLEM IDENTIFICATION <br /> Facility Name: _C 49 'a)oito . >m;• C14NAfUISAGufi JO!/VJe7 <br /> ❑ Second copy is missing Region 1 J2 3 4 (circle one) �O <br /> FacNty Specific Form: l/ <br /> ❑ Revised box checked <br /> ❑ I. Notification Categories - <br /> E3 Tiers marked do not match type of forams filed. <br /> ❑ N of forms attached do riot match total 1 of units. <br /> ❑ Tier 'A' checked with other tiers. <br /> ❑ 1I. Generator Identification <br /> ❑ EPA X incorrect missing <br /> ❑ Name/Address incomplete <br /> ❑ Contact Person/Phone P missing <br /> ❑ M. Type of Co.: Standard Industrial Classification.Code - 'ssing `' <br /> ❑ VI. Attachments (missing): J` <br /> Certification(s)El <br /> Y <br /> Plot Plan missing <br /> nat << D <br /> i�i', sinal <br /> ❑ Questionable title <br /> ❑ No original signature on both its Py1�19 ��rI � <br /> Unit Specific Forms: o l <br /> ❑ Unit Name/Unit ID X - missing �t�' ("� ��• <br /> ❑ Number of Devices - no # (x is unaoceptabl sot Pa \v1 J�v 6, <br /> I. Wastestreams do Treatment Processes A1e. <br /> 13 <br /> Total'Volume Treated - no quantity �1,a <br /> ❑ ,Wastestreams-- none marked <br /> ❑ Certified Technology - certification y missing r <br /> 13 II ����' inti <br /> . native Descriptions - Blank 1 2 3 vim` �° 5 <br /> ❑ M. Residual Management - 13 - letter not checked when Yes (o can be blank) <br /> ❑ IV. Basis For Not Needing A Federal Permit - missing <br /> ❑ V. Transportable Treatment Unit - if marked, set aside for special handling Q' Z bZ do- <br /> Additional Comments/Problems: a "c' L <br /> Reviewed by Dau: P <br />