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FORM 1772--ADMINISTRATIVE REVIEW PROBLEM CHECKLIST <br /> Facility Name: Q c,a(oc ID #: LgL 00 O 0 yTC? y2-1 <br /> Check appropriate blocks for problems found (dc explain if necessary) <br /> ❑ Second copy is missing <br /> Facility Specific Form: <br /> ❑ Revised box checked <br /> ❑ I. Notification Categories - <br /> El Tiers marked do not match type of forms filed <br /> ❑ Number of forms attached do not match total number of units <br /> ❑ Tier 'A' checked with other tiers. <br /> ❑ II. Generator Identification - Check all that apply <br /> ❑ EPA # incorrect/missing <br /> ❑ Name/Address incomplete <br /> ❑ Contact Person/Phone # missing <br /> ❑ III. Type of Company: Standard Industrial Classification Code - Code missing <br /> VI. Attachments - Missing (if there, mark boxes if necessary) ,'S /27;SS' <br /> S <br /> Certifications <br /> ❑ No signature/title/date <br /> ❑ Questionable title <br /> ❑ No original signature on both copies <br /> Unit Specific Forms: Unit # <br /> ❑ Unit Name/Unit ID Number - Information missing <br /> ❑ Number of Treatment Devices - No number (x is unacceptable) <br /> I. Wastestreams and Treatment Processes <br /> ❑ Total Volume Treated - No quantity <br /> ❑ Wastestreams - None marked (circle marked ones, top form only) <br /> ❑ Il. Narrative Descriptions - Blank 1 2 (Circle blank section.) <br /> ❑ IIl. Residual Management - #3 - letter not checked when Yes (others can be blank) <br /> ❑ IV. Basis For Not Needing A Federal Permit - Nothing Marked <br /> ❑ V. Transportable Treatment Unit - If marked, set aside for special handling <br /> Additional Comments/Problems: V Pw + �y �-( 0 Tk eAT^' e,,)73 uA)✓T�f' <br /> Reviewed by &M Date: �/�IJ <br /> Problems Handled by: Date: Rev. 4/17/93 <br />