Hardous Waste Permit Information Form - Kansas Department Of Health And Environment
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12EPA ID Number
Kansas Department of Health and Environment
HARDOUS WASTE PERMIT INFORMATION FORM
1. Facility Permit
First Name:
MI:
Last Name:
Contact
Contact Title:
Phone:
Ext.:
Email:
2. Facility Permit
Street or P.O. Box:
Contact Mailing
Address
City, Town, or Village:
State:
Country:
Zip Code:
3. Operator Mailing
Street or P.O. Box:
Address and
Telephone Number
City, Town, or Village:
State:
Phone:
Country:
Zip Code:
4. Facility Existence
Date
Facility Existence Date (mm/dd/yyyy):
5. Other Environmental Permits
A. Facility Type
B. Permit Number
C. Description
(Enter code)
6. Nature of Business:
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