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NUMBER:
STATE:
PRIMARY INDUSTRIAL CLASSIFICATION(SIC)
CATEGORY
IS FACILITY PERMITTED BY IEPA OR USEPA?
ZIP:
WARD:
PRIMARY SIC NO._________________
NAIC CODE:_________________
YES
NO
IF YES, IEPA OR USEPA PERMIT NUMBER: _______________________________
DOES PERMIT SPECIFY LEAD EMISSION LIMIT?
YES
IF YES, WHAT IS THE LIMIT? ____________________________Lbs/yr
ENVIRONMENTAL CONTACT NAME:
Email Address:
Contact Phone No.:
OWNER OR OPERATOR INFORMATION
NAME:
ADDRESS:
CITY:
Email...
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