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Please print or type with ELITE type (12 charm )r inch) in the unshaded areas only '^ AOPmvsa. orwe NO X50 -X28 <+was 3-3C-% <br />- - - <br />Pledwing Not cationuc7,nns Notification of Regulated for Filling Not/5utfan txfore <br />completing 1111• form. The A <br />55A VO. �li6 t�9Ci <br />Date Received <br />7 <br />inlormallon nr♦ueated here is �.►,Epq Waste Activity <br />required by leo (Section 301 a <br />(for Official Use Only) <br />of Lha Resource ConaervetMn <br />and gecarsry Act} United States Environmental Protection Agency <br />I. Installation's EPA ID Number (!Nark 'Xin the appropriate box) <br />❑A. First Notification � B. Subsequent Notification C. Installation's EPA ID Number <br />(Complete item C) C A r �/ q <br />`/" <br />l vr7 <br />11. Name of Installation (include Company and specltfc site name) <br />i /`fI P C1 2 ,4 T / �� n' <br />HI. Location of Installation (Physical address not P.O. Box or Route Number) <br />Street <br />�� <br />/`tib( <br />!E <br />S <br />EES <br />Street (Continued) <br />City or Town State <br />ZIP Code <br />tri <br />4h'aNamwe <br />- <br />�l5 <br />3 <br />/ <br />- <br />Co nn � <br />�'7 � 141 1 1Al <br />IV. Installation Mailing Address (See 1n ructlons) <br />Street or P.O. Box <br />C1 <br />City or Town _ State Zip Code. <br />AI ti' _ i": A. 191513131-7V. <br />Installation Contact (Person to be contacted regarding waste activities at site) <br />Name (Last) (First) <br />Job Tltte - <br />Phone Number (Area Code and Number) <br />Al A 41- s � <br />VL Installation <br />Contact <br />Address (See instructions) <br />A. Comract <br />lor+tlon <br />Address <br />tasxq Darr <br />B. Street or P.O. Box <br />i <br />! <br />City or Town Stats Ilp Code <br />I <br />A. Name of installation's Lags( Owner lCitklflPf L'-!' �� �2 i1 ` ��'<, i': <br />L1, G P - <-) c ,P A <br />Street, P.O. Box, of Routs Number <br />City or Town SttJate Zip Code <br />iA <br />1, <br />/.. <br />14 <br />5 <br />JJ <br />Phone Number (Area code arta Number B. Lana Type <br />( ) <br />C. owner T a Cha nqe or owner <br />Type Indictor C��ed) <br />Mpete <br />year <br />��A Fv�in orutr iz (Hev. 11-30-93) Previous edition is obsolete. Continued on Reverse <br />