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EPA M NUMBER M i1_ <br /> Page ' cf LJ <br /> HAILING ADDRESS, Q DIFFERENT': <br /> COMPANY NAME (DBA) <br /> STRE!J�, <br /> CITY STATE _ ZIP <br /> COUNTRY <br /> (od7 cc"&"@ if m USA) <br /> CONTACT PERSON (tom Namr) PHONE NUMBER(____) <br /> flat Naar) <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use a dw one or neo SIC code (a four dJfu nambar)that bet dambe your conWany'r <br /> product, rerhaes, Or induttriaf aai"ry. <br /> zub"pic 22& �nithlnr fab <br /> d47j Priivad tirc+tir boards <br /> First Semod: <br /> TV. PRIOR PERMIT STATUS: Cheot yes or no to esM quetion.. <br /> YES NO <br /> ❑ 1. Did you file a PBR Notice of(moot to Operate (DISC Form 6/62) in 1992 for this locWoo? <br /> ❑ ® 2. Do you now have or have you ever bold a so" or fadwW baardotu waan facility full pa=t or mtenm <br /> pp�1 status for any of thins traatm ns units? <br /> ❑ tc]I 3. Do you now have or have You ever bald a ave or hdwW frill permit or interim emn for any abet <br /> t� <br /> hazardous waste sm"I 01 at this location? <br /> ❑ 4. Hm you ever bold a vanaow tatted by the Daper=am of Tosie Substances Castrol for the tteawwat you <br /> an now ooufyie6 for at this location? <br /> ❑ 3. Has this lo=bm over ban inspaed by the state or my local agmcy a a baartlom waste gaaarw r? <br /> V. PRIOR ENFORCEMENT HISTORY: Nat papard fivm smeasees aJpI 1 . dxmwt <br /> U <br /> YES NO <br /> ❑ ❑ Withm tbs let tbr.e YMM hm this feahty berm the subject of my convictions,jodiMmM adwoo es. or final <br /> frost m acute by my local, vete, or fadael mvitootnmral. bsasdar wast6 at pablie hasith <br /> (For the purpom of this form, a mot=of violation 4001 001 ocaatians m ordv and and not be r.portsd uolew <br /> it w01 act corrected and became a final order.) <br /> ❑ U you uwwered Ya, cheek this boa sod attach a Bating of wovicuooa,jud6meau4 attlammts.or orders and a copy <br /> Of the cover abet from sari document. (See the Insuvcuom for mon uu%rmstion) <br /> DT3C 1772(1197) _l. lFw- <br />