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TRANSMISSION VERIFICATION REPORT <br /> TIME : 12/12/2014 14: 29 <br /> NAME SJC EHD UNIT 3 <br /> FAX 20946$3433 <br /> SER.# BROM7F534354 <br /> DATE DIME 12/12 14:29 <br /> FAX NO. /NAME 919162554703 <br /> DURATION 00: 00:23 <br /> PAGE(S) 01 <br /> RESULT OK <br /> MODE STANDARD <br /> ECM <br /> State of California—Califomia Environmental protection Agency <br /> E1gPartmenf of Toxic 5ubsksnrx;s Control-GISS <br /> P.Q.Bok$06,&acrd vrnto,CA 95812-(1808 <br /> CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br /> Please type or neatly print in ink. Please review the line-by-)ins instructions carefully. <br /> To check on the_ s _fetus of our oast,go to www itwts disc ov and click an Reports. <br /> NEW EiLIMBER REQUESTS Check ail that apply. <br /> f � lam applying for a new (See instructions,) <br /> Permanent California its number as a hazardous waste: q-.G4nerator E7 Transporter <br /> Reasan for neve number: A. Il Lever had a number B. 0 Business movers C, ❑ Legal owner of business changed <br /> If your bus{ness generates greater than loo kg'of RCRA hazardrlus waste per month, ea{I(415) 495-5$95 for a federal{D number, <br /> F21 <br /> $TAT $4R 1fVFORMATI N F R N EXISTIN tD Nt1M13r R <br /> number' C A (See instructions.) <br /> dating the mailing address and/or contract informstlon only. <br /> activating this ID Number. <br /> ❑ 4. 1 2m reactivating this ID Number. <br /> G 5. 1 am changing the business name only, no ownership change. <br /> 6, Site/Facility/Susmess Dame(Include IBA): 2�T A f ��{ (See instructions,) <br /> 7 Site Location: I. j.4w q a <br /> tr et <br /> City <br /> 8. (a) Federal Employer ID Number zip County <br /> (b) Burd of Equalizatlan Fee RCCount dumber <br /> ((b)is only required from generators of greater than 6 tons per calendar year. <br /> 9. Mailing Address: (See instructions.) <br /> Street <br /> Crty State 7jp <br /> 90. Site Contact Person ! fi <br /> (See i'nstructirns.) <br /> First Name Lask h[ame <br /> Contact Person Address: 4 l L� Ll L&� � <br /> ItY State Zip <br /> Contact Person Phone Number. --E2��O�� Fax Number- ( ) <br /> Area Code Phone Number Area CM- <br />