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DEC 14 2004 <br /> Depanrnent of Torzic Substances Control <br /> Stare ofCalifomia-CabiomiaEmir°no=talP1p1mtiO°Agmc ENVIRONMENT HEALTH P-0-Box ao6 <br /> PERMIPSERVICEc s Q1e to,CAvsgtz-0806 <br /> California Hazardous iWaons sst ePermanentlly and eID all iNmm`�s on the Application <br /> p P�nation <br /> Ple <br /> e review <br /> 1. Application for a permanent California TD number as a: Generator ❑ Transporter ❑ Both <br /> 2. This site is a: ❑ Large Quantity Generator mall Quantity Generator <br /> 3. Chan in previously issued ID number: <br /> Inactivate ❑ Reactivate ID Number:------------ <br /> 4. Site/Facility Name: titi t 4� 51 <br /> Sig �r2m�n <br /> 5. Site Location: J- <br /> s <br /> SVQd gk 0o n CA- 65�� t /1 ut I Y) <br /> State LAP <br /> C4 <br /> City f <br /> 6. UlingAddress: I V-crylG <br /> `` City Statz Zip <br /> Site Cc:rTa:.t Peron- <br /> [7. I <br /> it *,, <br /> ConiaclPer ot,[Alahc-;s: <br /> G <br /> , Stqw4 <br /> Jt-yi. �i.• t '— <br /> Ciry State �•rP <br /> 1 u" ty,GJ t Fax Plumber: �- - <br /> Contact Person Phone Number: f ? C1 Arca Code t:ax Numoer <br /> 1 Area Code Phone Number <br /> 'noes Email A3nrrsC' •"t` <br /> Co o^ ca Brt E_._.. . _ — _ <br /> rteaMM_...._. <br /> I P(afzri Email <br /> Pfis .. <br /> ary n caztca: <br /> 8_ Legg:Q'+nr, <br /> r <br /> qq ! tiSA <br /> uwrec nuia5 J V . City Stale 7tn <br /> I <br /> 'I lir cast ��, v I <br /> 1 t)WIIEF YitOne fVumber: t k�� _.r _ i <br /> Area Code Fltvtec number <br /> d-Digit Nrmhlu) <br /> :rI <br /> �. <br /> ! 4. Stannard itratusutm <br />