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RPB-14-2075 22:43 FROM: T^:4683433 P.518 <br /> tee/ <br /> State at California-Cautomia Environmental Protedlon Agency Department of Toxic Substances Control-GISS <br /> ReSAC'FO[tn Pent' P.O.Box 808,Sacramento,CA 85812-0808 <br /> CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br /> Please typo or costly print in ink. Please review the Tina-by-lima instructions carefully <br /> To check on the status of your reguest, o to caw .hwt C and dick on Reports. <br /> NEW NUMBER REQUEI}T$ Check an that anoly. (See instructions) <br /> F1 1. I am applying for a new permanent California 10 number as a hazardous waste' Generator oTranaporter <br /> Reason for now number- A. Never nevi a number B. [] Business moved C. Q legal owner of business changed <br /> lr your business nerates greater lien <br /> I00 kg of RCRA hazardous waste per month,contact US EPA ror a fodoral ID number, <br /> CHANGES TO U R I FRMAT B R (See instructions.) <br /> For existing ID number- C A Q rt z 3 <br /> n 2. I am updating the mailing address and/or contact information only <br /> - <br /> Q 3. 1 am Inactivating this 10 Number. <br /> E�S 1 am reactivating this ID Number <br /> © 5. 1 am changing the business name only, no ownership change. <br /> ty ( ) Auto S,peci A �S (See Inshucfbns.) <br /> 8. Slte/F8G711 /Business Name(include OBA: <br /> 7. Sita Location: �q tp W. it ", � _- <br /> Tac�r _ r,.4, ts3oy Sky, J�Aq ul�n <br /> city �'- 385969 state zip County <br /> 8.(a)Federal Employer ID Number QQ" Board of Equalization Fee Account Number _ <br /> (b is only required from generators o/greeter than 0 tons par Calendar r.) <br /> -7q l (See inswcrlons.) <br /> 8- Mailing Address' <br /> street Y 64 9 T30'L( <br /> Com' state zip <br /> \,��" (Sea Instructions.) <br /> 10. Site Contact Person: `yL ry,{{�S 1YVJWIQSOY� <br /> First Name Leak Name <br /> Contact Person Address: '74 t k w. t ST. <br /> stgz -�cy C Y4 q 530{ <br /> City State '1n6'g9 2 <br /> QI <br /> o <br /> Contact Person Phone Number, r Q 3-3 IMO Fax Number 93 3 - <br /> Area Coda Phmre Number Ama Coda Fax Number <br /> w�.k/ <br /> Contact Person Business Email Address: \ ^� Preferred Primary CommuMagon:IiQMNI ❑Emaii <br /> (S" <br /> 11, Legal Business Owner(not property owner): J►ar,•,G$ �- `1� nS�Tt J ti• �) <br /> Owner Address. -14 i e Imo. t ► �'a (A- j 536y <br /> Street opd city slate z10 <br /> m► , <br /> Owner Phone Number cag 33-3 Fax Number. Q-0—ft ) �{3j Tr2j a <br /> Area Code Phone Number Arae Code Fax Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: S 3 (4-0191t Number) (See lnsZ1ons.) <br /> 13. Certification: I certify under penalty of law that tho information on this document was prepared to the(rest of my knowledge and <br /> belief to be,mus,a a d complele. p <br /> SIGNATURE DATE <br /> NAME(print) J)ArmeSU-AxyJK $/f j <br /> TITLE �W PHONE (X9)931-311Nd <br /> OTSC Form 1358(8/08) <br />