1. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES

2. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELTTERIOUS SUBSTANCES This presentation will assist you in the completion of the Form 1020A. The application for certification under the recycling, reuse of deleterious substances. Date of Last Revision: 2001 Rule Requirement: 10-8-1 and 10-8-2 Explanation of Form: Applicant shall file an original Form 1020A with necessary attachments with the Pollution Abatement Department. Form 1020A is filed prior to construction of facility or change of operator. [Reference 165:10-8-1 through 165:10-8-11] Question concerning this Form: For more information contact Pollution Abatement at (405) 522-2763.

3. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES COMPANY NAME

4. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES PHONE NUMBER

5. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES MAILING ADDRESS, FAX NUMBER, CITY, STATE, AND ZIP CODE

6. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES CONTACT PERSON’S NAME

7. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES TITLE OF CONTACT PERSON

8. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES FACILITY LOCATION - ADDRESS

9. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES FACILITY LOCATION – CITY STATE AND ZIP CODE

10. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES FACILITY LOCATION WITHIN THE SECTION – PROVIDE THE QUARTER SECTION CALLS, SECTION, TOWNSHIP, RANGE AND COUNTY

11. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES WILL MATERIALS OTHER THAN DELETERIOUS SUBSTANCES BE HANDLED (Definition of Deleterious Substances is found in OAC 165: 10-1- 2)

12. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES IF YES, PLEASE EXPLAIN

13. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES SCHEDULED CONSTRUCTION BEGINNING DATE

14. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES SCHEDULED OPERATIONS BEGINNING DATE

15. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES ANY ADDITIONAL COMMENTS

16. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES APPLICANT’S SIGNATURE BLOCK

17. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES NOTARY SIGNATURE BLOCK

18. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES SPECIAL INSTRUCTIONS FOR COMPLETING THIS FORM

19. FORM 1020A – APPLICATION FOR CERTIFICATION UNDER THE RECYCLING, REUSE OF DELETIOUS SUBSTANCES FOR OCC USE ONLY – Do not write in this space