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1-10-200S 11:14AM FROM P_2 <br />Dcpartment of Toxic Substances Control <br />State orCalifotnia-California Environmental Protection Agency P.O-Box 806 <br />Sacramento, CA 95812-0806 <br />California Hazardous Waste Permanent ID Number Application <br />Please review the instructions carefully and complete all items on the application. <br />1. Application for a permanent California ID number as a: enerator D. Transporter ElBoth <br />2. This site is a: p Large Quantiry Generator f�mall Quantity Generator <br />3. Change in previously issued ID number: <br />❑ Inactivate ❑ Reactivate ID Number: c J2 V- p <br />4. Site/Facility Name: (� �� CV I ! -0::c <br />5. Site Location: <br />6. Mailing Address: S�"'^ &� <br />Street <br />7. Site Contact Person: <br />Contact Person Address: <br />State <br />r.ast Name <br />Contact Person Phone Number: <br />FaxNumber: <br />Area% oda Phone Number Archh Code Fax Number <br />Contact Person Business Email Address: <br />Preferred Primary Communication: Mail ❑ Email <br />8. Legal Owner: t F'— <br />Nar <br />Owner Address: <br />Street <br />Owner Phone Number: G= <br />Area C <br />9. Standard Industrial Classificatic <br />L)TSC 1358 04/02/2003 <br />Phone <br />Code for the Site, <br />State Zip <br />