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State of California—California Environmental Protection Agency Department of Toxic Substances Control -HWMP P.O.Box 806,Sacramento,CA 95812-0806 PERS ANENT STATE ID NUMBER APPLTCATION Please type or neatly print in ink. Please review the line-by-line instructions carefully. To check on the status of your request,go to www.hwts.dtsc.ca. ov and click on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) © 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑ Transporter Reason for new number: A. ❑ Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed If your business generates greater than 100 kg of RCRA hazardous waste other than those hazardous waste listed in 40 CFR 261.5 subparts(c) and(d), per month, complete Form 8700-12 for an EPA (federal) ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER (See instructions.) For existing ID number: C A _ D_ O Q L4 1 S 1 3 E) 2. 1 am updating the mailing address and/or contact information only. ❑ 3. 1 am inactivating this ID number. ❑ 4. 1 am reactivating this ID Number. ❑ 5. 1 am changing the business name onl , no ownership change. 6. Site/Facility/Business Name(Include DBA): EVOLUTION EQUIPMENT SERVICES INCe instructions.) 7. Site Location: 17840 N. BRUELLA RD. Street LODI CA 95240 SAN JOAQUIN City State Zip County 8. (a) Federal Employer ID Number 47-2741280 (b)Board of Equalization Fee Account Number N/A b is onI re uired from enerators of neater than 5 tons per calendar ear. 9. Mailing Address: P.O. BOX 827 (See instructions.) Street VICTOR CA 95253 City State Zip 10. Site Contact Person: BRAD SPORLEDER (See instructions.) First Name Last Name Contact Person Address: 17840 BRUELLA RD. Street LODI CA 95240 City State Zip Contact Person Phone Number: (209 )810-5796 Fax Number: (866)250-9489 Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: brad le S orleder mail.COm Preferred Prima Communication: ❑ Mail LEJ Email 11. Legal Business Owner(not property owner): BRAD & MARTI SPORLEDER (See instructions.) First Name Last Name Owner Address: 17840 N. BRUELLA RD. Street LODI CA 95240 City State Zip Owner Phone Number: (209)810-5796 Fax Number: (866 )250-9489 Area Code Phone Number Area Code Fax Number (See instructions.) 12. Standard Industrial Classification (SIC)Code for the Site: 3 5 9 9 (4-Digit Number) (See instructions.) 13. Certification: /certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to be, true, ac cur to and comp ete. SIGNATURE DATE 3/21/2016 NAME (print) BRAD SPOR DER TITLE VICE PRESIDENT PHONE (209)810-5796 DTSC 1358(5/29/15)