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