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. . . • • Stale of California-California Environmental Protection Agency Department of Toxic Substances Control-GISS P.O.Box 806 Sacramento,CA 95812-0806 California Hazardous Waste Permanent II) Number Appfication Please type or neatly print in ink Please review the line-byline instructions carefully. To check on the status of your nuest,go to www.hwts.dtsc.ca. ov and click on]?-- New New Number Requests. Check all that apply. (See instructions.) .r 1. I am applying for a new permanent California ID number as a hazardous waste: Q( Generator ❑Transporter Reason for new number: A. �K Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed Ifyour business generates greater than 100 kg ofRCRA hazardous waste per month, contact US EPA for afederalID number. Chauees to Status or Information for an Existing ID Number. (See instructions.) For existing ID number: C A ❑ 2. I am updating the mailing address and/or contact information only. —1:1 3.3. I am inactivating this ID Number. ❑ 4. I am reactivating this ID Number. ❑ 5. I am changing the business name. There has been no ownership change. 6. Site/Facility/Business Name(Include DBA): <,eof L,f\Q vv $ LLC, (See instructions.) 7. Site Location: fj LAO (V rt~V Z s-§ Street SAvr-\rT0 , C 'DL. City State Zip County 8.(a)Federal Employer ID Number:51 I-38 5 6 6 6(b)Board of Equalization Fee Account Number: (b)is only reguiredfrom generators ofgreater than 5 tons per calendar year.) (See instructions.) 9. Mailing Address: 0133 O1 a V-�vs.e�n Cq �,>; .� L"', #30 C� S et A-oc\t-co... C ear `k Sed,0 city State Zip 10. Site Contact Person: L CF 6- 4 I V-�'T (See instructions) First Name Last Iiame Contact Person Address: 9.SS'� W lRvhw.e- :-�c C '3f:, Street �'roc�ccro� C-ear g Sa o2 City State Zip Contact Person Phone Number: D`'i Ll b 9 0 6/ ,1 Fax Number: 6t0 9 � 7�{ - O SC)y Area Code Phone Number Area Code Fax Number Contact Person Business Email Address:_ 0 5•�pe a�\pbg\ NQS Preferred Primary Communication: ❑ Mail JV Email rd 11. Legal Business Owner(not property owner): W (I. o N c�nie.� a (_L C. (See instructions.) Name c Owner Address: rr,�3 `\_ LN \'\ street City State zip 6 ic>6M .- CR Owner Phone Number: &O• y G`{ o G s,-( Fax Number: 2,9,1) y 4-o-5,o �j g se,oc Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification(SIC)Code for the Site• s a (4 Digit Number) (See instructions) DTSC Form 1358(5/07) www.dtse.ca.gov