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08/20/2008 15: 28 2093338256 INJECTION-MOLDING-CO PAGE 03/04 <br /> State of California-California EnvironmentI!TProlection Agency - - apartment of Toxic Substances Control-GISS <br /> P.O.Box 806,Sacramento,CA 9$812-0806 <br /> R�'s�E;Ftir`tS5 P�i',nt `� <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.dtsc.ca. ov and click on Reloofts. <br /> NEW NUMBER REQUESTS Check all that apply. (See instructions) <br /> 1. 1 am applying for a new permanent CalifOmig ID number as a hazardous waste: a Generator CjTransporter <br /> Reason for new number: A. ❑ Never had a number B. ❑ Business moved C.IMLegal owner of business changed <br /> If your business generates greater than 900 kg of RCRA hazardous waste per month,contact US EPA for a federal IO number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) <br /> For existing ID number. C A _-- ! _ _ _.__- _ _ — <br /> ❑ 2. 1 am updating the mailing address and/or contact information only. <br /> E] 3. 1 am Inactivating this ID Number. _ <br /> © 4. 1 am reactivating this ID Number. <br /> ❑ 5. 1 am changing the business name only, no ownership change. <br /> /� f (See Instructions.) <br /> 6. Site/Facilhy/Business Name(Include D//SA): �^�? G 10� Mp a i.r,cl_e] S�I,�SLg,T 113, <br /> A <br /> 7. Site Location: �pp,�- ZN Gk M�4 <br /> L GhCYt i - C A <br /> city <br /> (b) Board of Equalization Fee Account Number <br /> ((b)is only required from generators of greater than 5 tons per calendar year.) <br /> �^ (See Instructions.) <br /> 9. Mailing Address: Q a',- .L1'I Gt'k C�C t d� W R�y L.d o� ."[ t <br /> SLo d C A _ <br /> city State ZIP <br /> L <br /> 10. Site Contact Person: Al�. ���Q{ �^ ���e c— (see instructions.) <br /> . r <br /> First Name Laol Nam® <br /> Contact Person Address: Q1�! � � CT- <br /> Street -0 <br /> L_nrf <br /> TSLorf <br /> City �r State Zip 3 � <br /> Contact Person Phone Number, (14A) �.3 ^� 1 Q Fax Number. (A(Zl ) 3 �— 2 a(a L <br /> Area Code Phone Number Area Code Fax Number <br /> !� r N � " . Ca^ <br /> Contact Person Business Email Address: � V h t s T1 ov. PI'Verrad P2ary Communication:0 Mail C&mail <br /> (See instructions.) <br /> 11. Legal Business Owner(not property owneQ: .Lh s L 1 J� � � �L4��. _( �f"1 <br /> time <br /> Owner Address: "t' -L✓°, c+ L1 J '1 C'v <br /> Street 3 ' y� City Stete � <br /> Owner Phone Number: 3 / Fax Number Opt 3 33� <br /> Area Coda phone Number `Area Code Fax Number <br /> 12. 6 <br /> Standard Industrial Classification (SIC)Code for the Site: 3 0 1 (4-01git Number) (Seelnstructions.) <br /> 13. Certification: i certify under penalty of law that the information on this document was prepared to the best of my knowledge and <br /> belief to be,true accurate an m rete. <br /> SIGNATURE�ZJ . � / -�. DATE_ . <br /> NAME(pi nt) /\RKr1JV �, e =�nbek& TITLE Ve-e. Ae iii air PHONE r 007- 3-3-3 a <br /> OTSC Form 1358(B108) <br />