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United States Environmental Protection Agency Please refer to the Instructions for <br /> Washington, DC 20460 Filing Notification before compleunp <br /> Owl' <br /> this form.The 4�informatiby on wsequesta <br /> wEPA Notifica�ion of Hazardous Waste Ad ivity 3010 of the R•iourve Consorrv:oen <br /> end Raeovary Acfh <br /> For Official Use Only <br /> Comments <br /> C <br /> Date Received <br /> Installation's EPA ID Number Approveld li me. do Y) <br /> F 1 1 1 <br /> I. Name of Installation <br /> a <br /> 11. Installation Mailing Address <br /> Str or P.O. Box <br /> 326 Ma � � s -r = LidAjUlg <br /> City or Townt IP e <br /> Ca q del <br /> III. Location of Installation <br /> Street or Route Number <br /> 5643 E FR* Mov STRc' E f <br /> City or Town state ZIP <br /> Sr o KTo tJ R q5 L asl <br /> IV. In tallation Contact <br /> Name and Title last, first end ob title Phon Number or e • nd number <br /> V ZCTo atT o Le t S 05 'I 1441 <br /> V. Ownership <br /> A. Name of Installation's L sl Owner B.T ofOwnership(enter code <br /> RvYGTo iz <br /> VI. Tvicio of Rs ulated Waste Activity Mer* 'X' in the eD ro riate boxes. Refer to instructions.) <br /> A. Hazardous Waste ActhriIhr B. Used Oil Fuel A <br /> Is,Csenomo, ❑ 1 b. Less than 1,000 kg/mo. ❑ 6. Off-Specification Used Oil Fuel <br /> ❑ 2 Transporter (enter 'X'snd mark appropriate boxes below/ <br /> ❑3.Treoser/Saw/Dapoer i�: lc. Very Small ❑ a, Generator Marketing to Burner <br /> 4 UndwIlround hilectlon Quantity Generat)r ❑ b.Other Markets <br /> ❑ B.Market or Burn Hazardous Waste Fuel <br /> /en(er'X'end mark appropriate boxes below) ❑ c. Burns <br /> ❑a.Generator Marketing to Burner ❑ 7.Specification Used Oil Fuel Marketer for On she Burner) <br /> ❑ b.Other Marketer Who First Claims the Oil Meets the Specification <br /> ❑ C. Burner <br /> VII.Wage Fuel Buming:Type of Combustion Device(•neer'X'inefleppropriste boxes to indicate typo of combustiondevicNs)in <br /> wfsrN hazardous waif•fuel or off-epesifxeflon reed oil fuel a burned See instructions for definitions of combustion devices.) <br /> ❑ A Utility Bones ❑ B Industrial Boiler ❑ C. Industrial Furnace <br /> VIII. Mode of Transportation tivensporlerS only— enter 'X' in the tiopropriate, box es <br /> ❑ A.Air ❑ B. Rail RC. Highway ❑ D. Water ❑ E.Other fspocdy) <br /> IX, First or Subsequent Notification <br /> Mark 7t' in the appropriate box to indicate whether this is your installation's first notification of hazardous waste activity or a subsepuent <br /> notification. If this is not your first notification, enter your installation's EPA 10 Number in the space provided below. <br /> �/ <br /> C. Installation's EPA ID Number <br /> EtA.Fru Notification C18.Subs quenl Notification(complete ham C) <br /> EPA Forth 9700.12 (Rev. 11.86)Previous eonion is obsolete Continue on ravers <br />