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Xi- t� <br /> `r .., <br /> State of California-California 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 ea PC% ++ <br /> Please review the line-by-line instructions carefully and complete all items on the application. 114, -Z-9-y-4-+o 3 <br /> New Number Requests. Check all that apply. (See instructions) <br /> m <br /> I aapplying for a new permanent California ID number as a: [J Generator [] Transporter _ <br /> Reason for new number: A. [J Never had a number B,[] Business moved C. [] Legal owner of business changed <br /> Changes to Status or Information. (See instructions.) <br /> For ID number: C A �� Q Q2 /[n�✓� <br /> [] 2. I am updating the mailing address and/or contact information only. <br /> [] 3. 1 am inactivating this ID Number. <br /> 4. I am reactivating this ID Number. <br /> 5. 1 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 /> [J 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/Facility Name: 1'yJANTe C4 71- E <br /> 8. Site Location: 201 ok-S7 E/J14PA1 <br /> Street <br /> ms u7_e G4 4s�3b <br /> City State Zip County <br /> 9. Mailing Address: <br /> 991✓Je- (See instructions) <br /> Street <br /> City State Zip <br /> n_ <br /> 10. Site Contact Person: _�! y �R�� (See instructions.) <br /> j'�fij �i/� Oa" <br /> First Name Lf' Na <br /> Contact Person Address: �22�b h/8s'7_ X�I9QS? <br /> Street mA.,yfee¢ 64 <br /> City State Zip <br /> Contact Person Phone Number: 0,05).20�- Z j•,3S -6 Fax Number: (2�r )Z��l'' 77,Z0 <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address: 1127_L✓/a31/1� t�`''�m*m�y� •C��� <br /> Preferred Primary Communication: fg Mail [] Email - <br /> //�� <br /> (See instructionr.) <br /> 11. Legal Business Owner(not property owner): G�� ��_Q0 C'�/ M . Va N S CL),i fi <br /> Name (� + /1. �t <br /> Owner Address: I'}a A _ C CL vV cAo, L-N, CQ�f t�'te-I A CL-J 9,a � <br /> StreetCity State Zip <br /> Owner Phone Number: (� a <br /> ) �D V—(Q DOO — $.'�( - (a <br /> Area Code Phone Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: (4-Digit Number) (See instructions.) <br /> DTSC 1358 10/03 <br />