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State of California—California Environmental Protection Agency Department of Toxic Substances Control-GISS FOt ti r P.O.Box 806,Sacramento,CA 95812-0806 Prin CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or neatly print in ink. Please review the line-by-line instructions carefully. To check on the status of your request,go to www_ .hwts_.d_ts_c.cp. ov and click on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) 1. 1 am applying for a new permanent California ID number as a hazardous waste: [I Generator El Transporter Reason for new number: A. E] Never had a number B. El Business moved C. R Legal owner of business changed If your business generates greater than 100 kg of RCRA hazardous waste per month, contact US EPA for a federal ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) For existing ID number: C A —L 0Q 2. 1 am updating the mailing address and/or contact information only. F1 3. 1 am inactivating this ID Number. Y4. 1 am reactivating this ID Number. E] 5. 1 am changing the business name only, no ownership change. � (See instructions.) f 6. Site/Facility/Business Name(include DBA): ??,eTuA C S 7. Site Location: �� N-E'cDfl,-e Vv-�r✓Cw Street J )' A a R CC/1 San �OaUv)'n City I _ , ( State Zip County�-- 8. (a)Federal Employer ID Number— Board of Equalization Fee Account Number ((b)is only required from generators of greater than 5 tons per calendar year.) 01 Nese \1y Uv'�I (See instructions.) 9. Mailing Address: Street{��,1^l /�/� l/IIV LY V p CM ��/��C) City( State Zip 10. Site Contact Person: C �<S W a 1 Ker (See instructions.) First Name I Last Name Contact Person Address: U Q 1 J.A �A treet ��0 s GL % ip� �'J D City /� � �/ �i Contact Person Phone Number: (�) ��' /X_81' Fax Number: 01 O/9O _ 0�U Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: Preferred Primary Communication:❑Mail [:]Email i ;oryl I�, (See instructions.) 11. Legal Business Owner(not pr(o/pierty'Iowner): /✓{�T�r �Gds r�C S , I �t-7 Owner Address: o G�K l,t�� QI e Elia il� I L& TN 47 I 1 o Street ret ,,� City State Zip Owner Phone Number: 051 2 ) /�' 4; — ;7goq Fax Number: ( ) Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification (SIC)Code for the Site: Q g a (4-Digit Number) (See instructions.) 13. Certification: /certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to be, tr�u.,e,�ccuurateand complete. SIGNATURE tom' r 1 u I.t / DATE l 2� T NAME(print) TITLE��Ll DTSC Form 1358(6/08)