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State of California–California Environmental Protection Agency Department of Toxic Substances Control -HWMP <br /> P.O.Box 806,Sacramento,CA 95812-0806 <br /> PERMANENT STATE ID NUMBER APPLICATION <br /> lease type or neatly print in ink. Please review the line-by-line instructions carefully. <br /> To check on the status of tour request.go to hitn:fAvxvY.t?:'_tS.dtst:.ca.Cro+/and click on Reports. <br /> NEW NUMBER REQUESTS Check all that apply. (See instructions.) <br /> 1. 1 am applying for a nevw permanent California ID number as a hazardous waste: © Generator ❑ Transporter <br /> Reason for new number: A. ❑ Never had a number B. ❑ Business moved C. E Legal owner of business changed <br /> If your business generates gre ter than 100 kg of RCRA hazardous waste other than those hazardous waste listed in 40 CFR 261.5 <br /> subparts(c)and(d),per month, complete Form 8700-12 for an EPA (federal) ID number. <br /> CHANGES TO STATUS OR 114FORMATION FOR AN EXISTING STATE ID NUMBER (See instructions.) <br /> For existing ID number: C A _ — <br /> ❑ 2. 1 am updating the mailir g address and/or contact information only. <br /> ❑ 3. 1 am inactivating this ID Number. <br /> ❑ 4. 1 am reactivating this ID Number. Reason(please select one): A. ❑ Verification Questionnaire B. ❑ Other <br /> ❑ 5. 1 am changing the busi ess name only, no ownership change. <br /> 6. Site/Facility/Business Nam (Include DBA): PIOUS PETROLEUM LLC (See instr <br /> 713 N E DORADO ST <br /> 7. Site Location: <br /> ST(}umrkT N CALIFORNIA 95202 SAN JOAQUIN <br /> City 47-3036956 State Zip County <br /> 8. (a)Federal Employer ID Nu ber (b)Board of Equalization Fee Account Number <br /> ((b)is only required from generators of greater than 5 tons per calendar year) <br /> 9. Mailing Address: 713 N ELDORADO ST (See instructions.) <br /> ,MGKTON CALIFORNIA 95202 <br /> City State Zip <br /> 10. Site Contact Person: G URANG VAGHASIA (See instructions.) <br /> First Name Last Name <br /> 713 N ELDORADO ST <br /> Contact Person Address: <br /> Sffe@CKTON CALIFORNIA 95202 <br /> City State Zip <br /> Contact Person Phone Nur ber. (202) 2356262 Fax Number: ( ) <br /> Area Code Phone Number Area Code Fax Number <br /> gasstockton@gmail.com <br /> Contact Person Business Email Address: Preferred Primary Communication: o Mail n Email <br /> 11. Legal Business Owner(no property owner): PIOUS PETROLEUM LLC (See instructions.) <br /> Owner Address: 713 N EL DORADO SiTne STOCKTON CALIFORNIA 95202 <br /> Stre 09 2356262 City State Zip <br /> Owner Phone Number: ( ) Fax Number: ( ) <br /> Arlea Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Classi cation(SIC)Code for the Site: 5 5 4 1 (4-Digit Number) (See instructions.) <br /> 13. Certification: I certify undr penalty of law that the information on this document was prepared to the best of my knowledge and <br /> belief to be,tru accurate and complete. <br /> SIGNATURE DATE 05/22/2017 <br /> NAME(print) GAURANG GH- ASIA TITLE MANAGER PHONE 510 361 9396 <br /> DTSC Form 1358(01/17) <br />