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Reference 27 Page 1'
Ma· 4 tt\ ~ UNITED ·s 1 ATES ENVIRONMENTAL PROTECTION AGENCY
REGIONS
April 20, 1994
HENELY'S CABINETS ATTN:TERRY HENLEY
n WEST JACKSON BOULEVARD
CHICAGO, IL 60604-3590
1310 N CAPITOL AVE INDIANAPOLIS IN 46202
RE: US EPA ID Number IND 982 616 112 -----------------------Location: 1310 N CAPITOL AVE
INDIANAPOLIS IN 46202
REPLY TO Tl£ ATTENTION OF:
In response to your correspondence of __ ·_o_3_-_o_7_-_9_4 ___________ , the following
information has been updated:
Name of Installation to Installation mailing address to
Installation contact to
HENLEY'S CABINETS 1310 N CAPITOL AVE INDIANAPOLIS IN 46142 TERRY HENLEY 317-638-6257
If you have any questions, please call me at (312) 886-6173.
Sincerely,
Sharon Kiddon RCRA Notifications Coordinator Waste Management Division
cc: State Agency File
;A
Print9d on Recycled Paper
Reference 27 Page 2
NOTIFIER DATABASE INFORMATION UPDATE FORM
y nle
Review the attached notification and change any information that is different from our current information. IF THE .LOCATION ADDRESS IS DIFFERENT DO NOT MAKE ANY CHANGES. Return the form to Marilyn Hansen.
NEW NAME (pirt old name into alias field)
PREVIOUS ID --------------------------------
LOCATION ADDRESS ----------------------~-----------------------
MAILING ADDRESS
CONTACT ----------------------------------- PHONE --------
LAND TYPE
STATUS CODE ----OFFICIAL FL -----
SIC CODES -----
GENERATOR ----l=LQG 2•SQG 3=CEG
COMMENTS
NAME
OWNER TYPE __
l=active S=out-of-business 6•non-handler 2=reg under other 10 3=dead mail
TRANSPORTER __ s•for own waste c•c011111erci a 11 y x•don ' t know
TSD -----
over •
Reference 27 Page 3
HWF-OM-FL ------- OSUOF-OM-FL
HWF-GMB-FL OSUOF-GMB-FL SPEC-OIL-MKTR __ UTIL-BOILER
AIR-FL
INCINERATOR SURF-IMPOUND WASTE-PILES
RAIL-FL
INDUST-BOILER --HIGHWAY
CONTAINERS LANDFIL OTHER
HWF-BURNER-FL OSUOF-BURNER-FL -------
INDUS-FURN-FL
WATER-FL
TANKS LAND-TREAT
OTHER
LAND-DISP-UNIV ------ STORE-TREAT-UNIV ------
COMMENTS ----------------------------------------------------------------
•.
Reference 27 Page 4
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY REGION 5
77 WEST JACKSON BOULEVARD CHICAGO, IL 60604-3590
REPLY TO THE ATIENTION OF:
March 28, 1994
HENLEY'S CABINETS ATTN:TERRY HENLEY PO BOX 795 GREENWOOD IN 46142
RE: US EPA ID Number
Location:
APR 0 7 1994
IND 982 616 112 ----------------------1310 N CAPITOL AVE
INDIANAPOLIS IN 46202
In response to your correspondence of _·_o_3_-_o_7_-_9_4 _________ , the following
information has been updated:
Name of Installation to Installation mailing address to
Installation contact to
HENLEY'S CABINETS PO BOX 795 GRE~NWOOD IN 46142 TERRY HENLEY 317-638-6257
If you have any questions, please call me at (312) 886-6173.
Sincerely,
~~~ Sharon Kiddon RCRA Notifications Coordinator Waste Management Division
cc: State Agency File
/1j:; Printed on Recycled Paper . : .. ·
Reference 27 Page 5• Please print cr type with ELITE type (12 chara~"''0rs per inch) in the unshaded areas only
form Approved. OMB "''o. ;aSJ-«;e. 1§14
GSA .\'o. C<"~-i:=A-ci
-1- Ccnt;nue on reverse
... I
-~ 0 UJ a:: UJ __ .... z w
Reference 27 Page 6
... •
Please print or type with ELITE type (12 characters per inch) in ~e unshaded areas only
·· ...
EPA Form 8700-12 (Rev. 9-92) Previous edition Is obsolete. • 2-
i-:;."" A.::Oo'e\-eo. CMe No. :<C!-0~28. Et:;•tel s,!CHi2 GSA No. o:us-&:.-or
Reference 27 P
age 71991 HAZARDOUS WASTE HANDLER
INFORMATION UPDATE
~~jt>(9~)/·
EPA ID, COUNTY
IND982616112 MARION
NAME, LOCATION ADDRESS, CONTACT
HENLEY CUSTOM FURNITURE INC 1310 N CAPITOL AVE INDIANAPOLIS IN 46202 TER.~Y HENLEY
HAZARDOUS WASTE ACTIVITIES:
GENERATOR: SMALL QUANTITY TSD FACILITY: TRANSPORTER: AIR: RAIL: H\tri: WATER:
CJIAN(iES '1'0 ABOVE IUFQBMA'l'Iotl:
Name:
Is this also a change in ownership?
~vcation Address:
Did you move?
Mailing Address:
Contact/Phone:
Ownership Change:
Date of Change:
ftAZARDQUS WASTE ACTIVITY: (see instructions for definitlons)
TSD - treatment, storage, disposal
LQG - large quantity generator
SQG - small quantity generator ·
f""'G - conditionally exempt generator
~nsporter (s) for our own waste
(c) commercially
Non-handler (6) * Out-of-business (5) * One time generator (6) *
~2.1. CURBEN'I'
* If you have checked any of these, we will deactivate your ID number and you will have to reapply for it if you need to use it again.
Comments:
7 /../_A _ __,/ Signature• ~/L...;:--.,..d ...!
Date: ~ - 1- · ~
OWNER, MAILING ADDRESS, PHONE
HENLEY KENNETH R 1310 N CAPITOL AVE INDI.A..'U\POLIS 317-638-2880
HAZ WASTE FUEL: GMB: OM: USED OIL FUEL: G.."!B: OM: SPEC USED OIL FUEL MKT:
IN 46202
BURNER: BUR..~ER:
~ .; Op 8
4,.;-;;0::-.:, . .Js -tt~ lr'4 j:,;· _c;· 'iif 'a . \ )....... :·· J/
UTILITY --BO'fLER: , !NDUST-R-lAt .. ,BQ!·LER: IN'DUSTRIAL "<F!JRNACE:
NEW IHFOBMATIQN UCUES'l'ED;.. ------~
Contact Address: ~ saine as location address
A, same as mailing address
different -------------------------------
OWners Address: same as location address __M_ ~ same as mailing address
difr~:z::ent ------------------
OWners Phone: ~_:g c(, (p, :?, s- 7 Recyclers: We are a : ___ (c) commercial recycler
_____ (r) non-commercial recycler
~~(n) not a recycler
Type of OWner/Operator: ~{p) private
__ (f) federal
Type of·Land:
SIC Codes: primary
secondary
__ (m) municipal
__ ( i) indian
~(p) private
__ (c) county
___ (d) district
__ (m) municipal
2434
__ (s) state
__ (c) county
__ (d) district
__ (o) other
__ (s) state
__ (f) federal
__ (i) indian
__ (o) other
•
1
I r 7 I Cdl. " .. • • * e- rr·· lf?f#tctt~ .•. ;tj
Reference 27 Page 8
~-
('itttJ 1' ~7 NOTIFIERS DATABASE
CHANGE OF STATUS FORM
EPA rD I MD qsztolb 1t2 PREVIOUS-ID
1=ln ~ she.5 -::t.tJ c.
file: :tA OtJ county: mARl
NAME c ~e.,W'Y'IC...t"Cl. f + NEW NAME u. ~ h le\...j
Sc.J·ron Cusfc~ turn\:b;re.. rtJc.
alias-one alias-two
MAIL-ADDRESS
MAIL-CITY,STATE,ZIP
LOG-ADDRESS
LOC-CITY,STATE,ZIP
COUNTY
**** PAGE 2 ************************************************** CONTACT Te-R-e-~ \:-k ~le.1 OWNERSHIP
PHONE
LEGAL-TYPE -------------------- (Type of ownership)
·sTATCODE --------------- CERCLA-CD ------------------ PCB-FL OFFICIAL-FL CONFIDENTIAL-FL
NOTIF-DT REVISE DT -------------------------
**** PAGE 3 ************************************************** GENERATOR ____ TRANSPORTER ___ TSD ___ ui ___ SQG __ _
HWF-GMB-FL ------------ HWF-OM-FL HWF-BURNER-FL OSUOF-GMB-FL ---------- OSUOF-OM-FL OSUOF-BURNER-FL SPEC-OIL-MKTR-FL
UTIL-BOILER-FL ___ INDUST-BOILER-FL INDUS-FURN-FL AIR-FL RAIL-FL HIGHWAY WATER-FL OTHER
**** PAGE 4 ************************************************** INCINERATOR-FL SURF-IMPOUND-FL WASTE-PILES-FL
LAND-DISP-UNIV
NAME:
___ CONTAINERS-FL -------- TANKS-FL ___ LANDFILL-FL LAND-TREAT-FL ___ OTHER-PROCESS -------
------- STORE-TREAT-UNIV
Reference 27 Page 9\ DEr 2 0 REC'D
DE \j 2 1 1ANS']) .t
STATE OF'INDTANA
BIENNIAL REPORT 1989
FORM 1: INSTALLATION IDENTI~l~~~lt~~~iF!ft~MJ
WHO MUST COMPLETE FORM I? Every site that receives this package.
INSTRUCTIONS: Please refer to the specific instructions before completing all forms. The information requested herein is required by IC 13-7~8.5-2.
I.
II. NAME OF INSTALLATION
Ill. INSTALLATION MAILING ADDRESS
City Or Town
IV. LOCATION OF INSTALLATION
V. HAZARDOUS WASTE ACTIVITY
Mark the boxes that reflect the activities at your facility in 1989.
0 Large Quantity Generator (G) generated 1,000 or more kg/month ofRCRA hazardous waste
~ Small Quantity Generator (SQG) generated between 100-1,000 kg/month of RCRA hazardous waste
CJ Conditionally Exempt Generator (CEG) generated less than 100 kg/month ofRCRA hazardous waste
0 Transporter (T) transported RCRA hazardous waste
CJ Treatment, Storage or Disposal Facility (TSD)
0 RCRA Exempt . treatment, recycling or disposal was conducted in RCRA exempt units
opera led under interim status or a final RCRA permit
0 Non handler Did not handle.RCRA hazardous waste because:
__ We never generated
__ We are out of business
_ Only excluded or de listed waste
__ Occasional generator (but none in 1989)
__ Other (Specify in Comments)
PAGE 4:- OF L (OVER) •
Reference 27 Page 10
Check to see ifitems II, IV, & V are identical to the information in the label on Form I. If not, please indicate why in the boxes. below.
VI. STATUS CHANGES
CJ a. We have moved.
D b. We have changed ownership.
CJ c. We have changed hazardous waste activity.
** If any of the above·three boxes are marked, you wtWneed to· flll'out the EPA Notification of Hazardous Waste Activity Form, and return it with this packet.
D d. We have gone out-of-business.
D e. We no longer handie hazardous waste.
** If you check either of these boxes, we will deactivate your EPA ID number and you may no longer use it without renotifying U.S. EPA, Region V.
~ f. We have changed our name (but not ownership).
VII. ST~NDARD INDUSTRIAL CLASSIFICATION (SIC) CODE (See Table I)
(2) _. - -- -- -- (3) (4)_ ------
VIII. INSTALLATION CONTACT
I Last Name
HI~IUILIGI~I I I I I I I I
IX. CERTIFICATION
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.
~eetLf i}£/PLF1/ SE(!6T!Ifl{ (A.) PRINT OR TYPE NAME ANDTITLE Please print or type with ELITE type (12 characters pe
State form 19288R Revised 8189
I()._-~--(-81 (C.) DATE SIGNED
PAGE OF
Reference 27 Page 11
1 i. Generetor 2. Trentpor\er
0 3. Truttr/Storer/Dispos_er $D__ ~ 0 4, Underf'OUnd lnJtction .
0. s.' Mertet Or lum Haurdou1 Wute Fuel . h(enr., 'X: •'!fl.'"'~ ''Pf'Ofllr'tft bortJ below} •. •: 0 1. Gtnlfltor Merhtina to Burner
~'· 0 b. Othlf .... ~.,., . \" : .....
.. .. .•. . .... . .. . . .. ~ ..
II.J• ,.. Vl••••r ----
PIIISI refer 10 lht lfllltllti10f11 ltr ''''"' Nor•t.ttr•on bel or 1 complell"l I hot rorm. 1he '"'0'"''"o" req_uetted here it r~uor.cf by Ia"" /Sttfroft 3010 of ll'tt RIIOIIIU Coftltn'llroll end lftto""" A ttl.
0 8. Off·Speclficatlor\ Uttd 011 Fuel · · . ,.t;":~;::.::::::;.~m:It·e ~ 'IJ ~ 'fj1 .. P b.OtherMarketer::;,.lfS.: D·~~'.l~ 1989 .WJ
·:· •• r .. · D .. ,... . ... '*'•. -·'····'· .................. ·••. -- • c. '~" . • •\ \ , .... • ' r, :,).;..~ .· . • . 'I r, • • ·•·
Cl ,:· Sp~tri~,,:"· UMCf ·on r:~.i M~rkat~<tJ~t·~·w.M:$ · · Who ~~r~ Clelma the on Mee11 '"· &.•m~iCft[Giott V ·
• • •• ... • • • • • • • • ••• : ; ·~ •• • •• - • • • •• • 0 ••••
VII. Waite uti urnlng~ Type of Combustion Devlat(tttt.,'lt'lfttlltP~''"'''"bo"''''"diurur•"'""'"'mlott dt.,iri(IJ/tt wllich hu~tdoul "''"' fuel"' oH·•peeiliutirm IISf!d oil fuel 11 burntd. $H ln1truetlon1 for dtfitthlottl ol COiflbUIIioll dt'IICII.J
D A. D 8. lnduttrlel toller 0
rll ·x: in the ·~~roprittt bo• ro indicate whether this It your lnttlllltlon't first noUflcetlon of heurdous wutt ectiviry or·e substauent not•lu:.tiiOn, ll ttut 11 not your I ~rat Mllh~nlinn, r.n1r.r your !nstllll!lon't EPA 10 Numblt In the apece provided be(ow.
EPA For"' 1700·12 (Rev. 1 1.n~•l J;;"ft;J_;;; ,., uh\nlr.I~'(L~ '1'\L-\-'~
Reference 27 Page 12
I. Hnardou• Wutea h'orft S~lflc Soun:u. Enter the four·diglt nurftber lrorft 40 CFR Part 21S1 .321or .. ch listed haurdous wasta hom IPK•hc aourcu your Installation tiendles. Use additional sheets If nacMiary •.
. I C. Commerclel Chemical Product Haurdou1 Wutu. Enter the four-digit nurftber from <&0 CFR Part '61.33 for tach chemical· ubstance
your inttalletion hendlu which mey be a hnerdous wute. U.s• additional aheeta If necessary. ·
U11.ct hlfectloua Wat1M. Enter the four·digit number from~ CFR Pert 281.34 for each hazardoul wasta from hospitals. veterinary tlol• pita Is. or medical aNt reuarch laberatories your Installation hendlel. Ute additiona1 aheets If nece11ary. .
l. Ctla,.r:tar4.,.u ef NoftllltM Hnerdou• Weatea. M11k 'X' In the boxes corresponding to the cherecterist,.;s or nonlia )d huardous Wll\11 your ina11111t1on hlrtcllll.($tt 40 CFR flrfl Ut.Zt- JII,ZtiJ . . : .... ,
~ ~·'•"habit . (J 1. corrotlve .. 0 3. Raectlve . . .... C "· ~~~~~ ~"~~ :~· [; · lOCO r J IDOOZJ ,... · ID0031 IDOOOJ :·"II . • !
: I ~ertify under penehy of lew thet I have per1onellr enm/ned end em femilier with '' ,, information •ubmittt 1/n ' this tnd ell lrttehed documents. end that b111d on mrlnqu/ry of thonlndivldut~ll,immedietely fllp.Jnlible for ! obtlining the lnformetion, I believe that the 1ubmltttd lnform•tlon /1 true, eccurlte, end complete. I'"" IWifl thet . 1 there are 1lgnilit:ent pene/ries for submitting 11111 Information, Including the poulbility of flne 1nd lm~Jtilonmtnt.
N1m1 lnd Otfloltl T1tl1 ff~l If ,r/nrJ