owners. Clearly identify the relationship(s) between the operator and all facility owner(s). Name: Address: City, State, Zip Code: Telephone Number: Charter Filing Number: Indicate the ownership status of the facility. Private: Corporation Partnership Proprietorship Nonprofit organization Public: Military State Regional County Municipal Federal Other (specify): List those persons or firms authorized to act for the applicant during the processing of the permit application. Indicate the capacity in which each person may represent the applicant (engineering, geology, legal, etc.). The person listed first will be the primary recipient of correspondence regarding this application. Include complete mailing addresses, phone numbers and e-mail addresses. For new, renewal, and major amendment applications specify the individual who will be responsible for causing notice to be published in the newspaper. Include the complete mailing address, telephone number, fax number and e-mail address. Describe the activities conducted by the applicant which require a permit. For amendment, modification, transfer or endorsement applications, briefly describe all requested changes to the permit and to the application contents and the reasons for the changes. Business Information Give a brief description of the nature of your business. List the principal products and/or services which are provided by your plant. Please itemize by Standard Industrial Classification (SIC) codes. Also label the products with their common names, if applicable.
owners. Clearly identify the relationship(s) between the operator and all facility owner(s). Name: Address: City, State, Zip Code: Telephone Number: Charter Filing Number: Indicate the ownership status of the facility. Private: Corporation Partnership Proprietorship Nonprofit organization Public: Military State Regional County Municipal Federal Other (specify): List those persons or firms authorized to act for the applicant during the processing of the permit application. Indicate the capacity in which each person may represent the applicant (engineering, geology, legal, etc.). The person listed first will be the primary recipient of correspondence regarding this application. Include complete mailing addresses, phone numbers and e-mail addresses. For new, renewal, and major amendment applications specify the individual who will be responsible for causing notice to be published in the newspaper. Include the complete mailing address, telephone number, fax number and e-mail address. Describe the activities conducted by the applicant which require a permit. For amendment, modification, transfer or endorsement applications, briefly describe all requested changes to the permit and to the application contents and the reasons for the changes. Business Information Give a brief description of the nature of your business. List the principal products and/or services which are provided by your plant. Please itemize by Standard Industrial Classification (SIC) codes. Also label the products with their common names, if applicable.