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- - - - - - ------. . _._...._.. <br /> Please type or maty prim to ink Please review the Ime-by-lira instructions carehdy. <br /> To Check on Bre status of)2ur request to www.tavts.dtsc.ca.aov and rSCc on Reports <br /> NEW NUMBER REQUESTS Cri heall that apply. (See instructions.) <br /> ❑ 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator oTransporter <br /> Reason for new number. A ❑ Ne <br /> Hver had a number B. 11 Business moved C. ❑Legal owner of business changed <br /> business generates greater then 100 kg ofRCRA hazardous waste per month,contact US EPA fur a federal ID number. <br /> FOR INF F EXIS NG ID NUM R (�instruchora) <br /> numberCA r <br /> dating the mailing address and/or oontad information only.ctivating this ID Number.ctivating this ID Number. <br /> hanging the des name only,no ownership change. y�`" <br /> [7. <br /> nefFaalityfeusi/ne�WNWM(rhWdooenr � t / ll f0 (�°u ') <br /> ite Location:Federat•Employer ID Number Board of Equalization fee Account Numbeer <br /> ((b)18 /soured from generators of greater Man 5 tons per Cak7rldar .) <br /> s. Mailing Addresa /�t# k/7i%l/(�a.1/D ltY "' 0"a) <br /> WPM <br /> 10. Site Contact Person: C�7 ��S ( &) <br /> Fast Name IN' <br /> m <br /> Coad Penson Address: <br /> t , <br /> nystate <br /> Contact Person Phone Number. <br /> Fax Number. <br /> Is P�rh—orha Nuftftr <br /> Arm Code Fax Number <br /> Contact Person Business Email Address: P� rNt��:L'1Maa d <br /> 11. Legal Business Owner(not property owner): �L fLit7 Y�T `.Ei'� (See inSlruCtiDR3•) <br /> Owner Address: fjl� NU�/�/Z <br /> Owner Phone Number / /_� Number. <br /> umber <br /> Arm CadaPlhorhe Number Area Code Fax <br /> 12. Standard Industrial Classification(SIC)Code for the Site: (4-13igi[Number) (See instaxtons.) <br /> [NAME <br /> ification: ! u»der prepared to the best ofmy knowledge and <br /> Y penalty of law Mat Me kdormanon on Mrs document was <br /> f to[he. <br /> accurate and cnmolate. <br /> URE,-� DATE /.07 <br /> rim) T fn„E ® . . PHONETSC Form 1358(6708) <br />