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• State of California-California Environment4litection Agency apartment of Toxic Substances Control-GISS Reset Form P O.Box 806,Sacramento,CA 95812-0806 Print CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION 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.) HF,1. I am applying for anew permanent California ID number as a hazardous waste: Generator Transporter Y Reason for new number: A. 21 Never had a number B. E] Business moved C. E] Legal owner of business changed If your business generates greater than 100 kg of RCRA hazardous waste per month,contact US EPA for a federal ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) For existing ID number: C A _ _ _ _ _ _ _ _ _ _ F12. 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 only, no ownership change. ,o (See instructions.) 6. Site/Facility/Business/Name(Include DBA): � nr PM �Li�"� / G._, 7. Site Location: / Oan r, Cie s r Street fTec%t /A Gj S kJ3 Un;7rol�7Rtr3 City State Zip County 8.(a)Federal Employer ID Number,31 0 Coo/,SSS Board of Equalization Fee Account Number /� ((b)is only required from generators of greater than 5 tons per calendar year.) 9. Mailing Address: /Oao F L k✓^t4 S7- r (See instructions.) `r t ("A �-( S 1 O 3'" fih cttt f s� or- City State Zip 10. Site Contact Person: JC a A,'- r (See instructions.) First Name / Last Name Contact Person Address: �(�I n �' tt L.,CL S St et ,A r.,. lA 'I Sao City qState Zip to2 Contact Person Phone Number: 09) .S I ✓/- L/0 r16 Fax Number: ( o L) Area Code Phone Number Area Code Fax Number Contact Person Business Email Address-SI, Ca3T/S%LrJdLI .1 1MCr5/tel-p„o .Corn Preferred Primary Communication:tMail ❑Email [ (See instructions.) 11. Legal Business Owner(not property owner): -51,aill. �n Name (c q Owner Address: _ 10a0 F C-Ll r.nr 4 S-5- Street f Street ,�(� city State L Zip Owner Phone Number: (2 a 9`/ 04> Fax Number: Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: _ (4-Digit Number) (See instructions.) 13. Certification: /certify under penalty of law that the intormation on this do cumentwas-prepared-to the best of my knowledge and belief to be, true,accurate and complete. SIGNATURE^-�/ DATE NAME(print) q.„ .c. nr, TITLE Ltr� Al^.r � PHONI11S9U/-YD.2 DTSC Form 1358(6/08)