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EPA ID NUMBER _DjajI <br /> Page 2 cf i <br /> MAILING ADDRESS, IF 2[E ERFM,: <br /> COMPANY NAME (DBA) <br /> STREbi <br /> CITY STATE _ ZIP <br /> COUNTRY <br /> (urr CO"m it eat USA) <br /> CONTACT PERSON (Fuw Hie.) PHONE NUMBER) <br /> (Lr Hser) <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or rwo SIC cadtt (a jour di,sit number) duu bar describe your Qmy%M s <br /> produc+, terviar, or bdtutrial aaivirv. <br /> zZmnp/t' a& �r aithinr fab <br /> Pritnsd ctrcvu boardr <br /> First: l �: Z Sated: <br /> TV. PRIOR PERMIT STATUS: C7wd yes or w to each quarrim. <br /> YES NO <br /> ❑ Mt I. Did you file a PBR Notice of intent to Operate (UM Form 9462) is 1992 for this location? <br /> 13 �pICI 2. Do you now have or have you ever held a state or fidwW haardoua waw facility full permit or intern <br /> stents for any of then tra um tit units? <br /> ❑ WI 3. Do you now haws or have you ever held a sten or federal fall permit of interim sten= for say other <br /> hazardous waw acuvu m to this lcration? <br /> ❑ 4. Have you ever bald a vrimce immured by the Depaftmamt of Toxic Substances Control for the treatment you <br /> are now notifying for at this location? <br /> ❑ S. Has this location ever been inspected by the vete Or my local apmey e a hazardous ween gmerator? <br /> V. PRIOR ENFORCEMENT HISTORY: Nee ropirdl►nw gourmws turfy f l f i U <br /> Mow NO <br /> ❑ ❑ within the Wt three yews, bas this facility been tee ebjm of any ea wwbons,jndgmmte, mde nes, or final <br /> orders fwukmt from an action by my local, mte. or federal getviiummmatel, heatdaus waan. or pubbc brlth <br /> aniorcemnew army? <br /> (For the purpoe s of tbu form, a Notice of violation does Oct camstitmte an order and meed ant be reported unless <br /> it was mot corrected and became a fins) order.) <br /> ❑ U you answered Yea, cbeck this box and attach a listing of convictioms,judgmemta,nukmmu,or Orden and a copy <br /> Of the cover ohm from each document. (See the instructions for more intorinanne) <br /> DTSC 1772 (IM) Page-2 <br />