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State of California—California Environmental Protection Agency Department of Toxic Substances Control-GISS <br /> Reset FormP.O.Box 806,Sacramento,CA 95812-0806 <br /> Print <br /> CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br /> Please type or neatly print in ink. Please review the line-by-line instructions carefully. <br /> To check on the status of your request,go to www.hwts.dsc.ca.gov and dick on Reports. <br /> _MEW NUMBER REQUESTS Check all that apply. (See instructions.) <br /> I am applying for a new permanent California ID number as a hazardous waste: ❑ Generator Transporter <br /> eason for new number: A. Never had a number B. Business moved C. ❑ Legal owner of business changed <br /> If your business generates greater than 100 kg of RCRA hazardous waste per month,contact US EPA for a federal ID number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) <br /> For existing ID number. C A L_ _Q_ O [J _0 G 9 Z <br /> L] 2. 1 am updating the mailing address and/or contact information only. <br /> F] 3. 1 am inactivating this ID Number. <br /> S�4. I am reactivating this ID Number. <br /> C] 5. 1 am changing the business name only, no ownership change. <br /> 6. Site/Facility/Business Name(Include DBA): G 13S O UTD!>GR (See instructions.) <br /> 7. Site Location: 2 CD5_0 w• <br /> Smelt TON t 'th • 957-0-3 SAN Jo-A6lU 1.W <br /> City State Zip County <br /> 8.(a)Federal Employer ID Number 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: <br /> SANIE AS AB0\ E (See instructions.) <br /> Street <br /> City State Zip <br /> 10. Site Contact Person: <br /> DRRESr PO R TERM (See instructions.) <br /> First Name Last Name <br /> Contact Person Address: ZD SO W Fi26M[�N`r s'7 <br /> <br /> <br /> <br /> UX66- So 21 Fax Number. (Zoq 1 46b - 6 U(3 <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address: {brre5f- Preferred Primary Communication:❑Mail ❑Email <br /> G ILJ tit'J(� O U� 1 OY <br /> 11, Legal Business Owner(not property owner): O ' (See instructions.) <br /> Owner Address: Shelcj�SU.5 Kwy�y(o r-Fle(G� NS 07cb'( <br /> She city sta� 3 <br /> Owner Phone Number: ( �f(o(o �c502.( Fax Number. (2P y�v(o- �� <br /> Area Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: 7 2 ! (4-Digit Number) (See instructions.) <br /> 13. Certification: I certify under penally of I a the information on this document was prepared to the best of my knowledge and <br /> belief to be,tare,arc and c tplet <br /> SIGNATURE DATE ��' <br /> NAME(print) ay TITLE PHONE-)O?-LW'&- 52)1t" <br /> DTSC Form 1358(6/08) <br />