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State of California-Califomia Environmental Protection Agency Department of Toxic Substances Control <br /> - P.O.Box 806 <br /> Sacramento,CA 95812-0806 <br /> California Hazardous Waste Permanent ID Number Application <br /> Please review the line-by-line instructions carefully and complete all items on the application. <br /> New Number Requests. Check all that apply. (See instructions.) <br /> (] 1. I am applying for a new permanent California ID number as a: [] Generator [] Transporter . <br /> Reason for new number: A. [] Never had a number B.[] Business moved C. [] Legal owner of business changed <br /> Chan es to Status or Information. (See_instructions.) <br /> For ID number: C A _ _ / .3 �e q Lv3_ _ <br /> [J 2. I am updating the mailing address and/or contact information only. <br /> [J 3. I am inactivating this ID Number. <br /> 4A4. I am reactivating this ID Number. <br /> 5. I am changing the business name. There has been no ownership change. <br /> 6. This site is a: [] Conditionally Exempt Small Quantity Generator of RCRA Waste (See instructions) <br /> [] Generator of less than 1,000 kg/month Califomia-only waste <br /> [•@.Generator of greater than 1,000 kg/month Califomia-only waste <br /> 7. Site/FacilityName: <br /> 8. Site Location: �fi20 t`tleOBft_ <br /> Street <br /> ETock"raA) CA 9Sz0lo -377 Jon Vi>1 <br /> City State Zip County <br /> 9. Mailing Address: O Qito..[1,•) S. � (See instructions) <br /> Street <br /> Ck-rotil C1 �S olo-3999 <br /> City <br /> f State Zip <br /> it <br /> 10. Site Contact Person: t I A& �4 �k L)Af!q (See instructions) <br /> First Name Last Nam <br /> Contact Person Address: - FOAO S „o,�n,�-�Lt-41V <br /> Street <br /> STod�Ta� Gl • 5;S2oti -3.9� <br /> City State Zip <br /> Contact Person Phone Number: (709) 983- J 4/Zo Fax Number: (� ?os- 6,197 <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address: <br /> Preferred Primary Communication: Mail [] Email <br /> cttons.J <br /> 11. Legal Business Owner(not property owner):� OFFICE OF THE ADJUTANT GENERAL i <br /> ru <br /> Name ATTN: <br /> Owner Address: 9800 Gothe Road <br /> Street P.O.Box 269101 <br /> Owner Phone Number: ( Sacramento,CA 95826-9101 <br /> Area Code Phone N. <br /> 12. Standard Industrial Classification(SIC)Code for the Site: (4-Digit Number) (See instructions.) <br /> DTSC 1358 10/03 <br />