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• MAR.12.2004 2:12PM LFRFNGINEEREDS4STEMS N0.309 P. 2 <br />State of California — California Environmental Protection Agency 8 cY Department of Toxic Substances Control <br />P.O. Box 806 <br />Sacmmcnto, 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 />Application for a per=nent California ID number as a: Generator 0 Transporter ❑ Both <br />This site is a: 0 Large Quantity Generator esrn2ll Quantity Generator <br />3. Change in previously issued ID number: <br />❑ Inactivate ❑ Reactivate <br />4. Site/Facility Name: <br />ID Number: C.,6} 1._ d CL(l ai g�i =H3 <br />5. Site Location: C r e /L/n e -/C <br />Street <br />/ sQTI/f7� GA Gj5�307ivd_GZ[1C� <br />City State Zip County <br />6_ Mailing Address: V 6 mnc / / Z <br />CNmnt <br />7. Site Contact Person: <br />Contact Person Addre: <br />State <br />State <br />LIP <br />Contact Person Phone Number: Q )qg�-5 Fax Number: <br />Area Code Phone Number Area Code Fax Number <br />Contact Person Business Email Ads <br />Preferred Primary Communication: <br />8. Legal Owner: <br />G Email <br />Owner Address: V6Co �4riptk ye-&4ol C-,rfea- <br />Street City State Zip <br />Owner Phone Number (tt) <br />Area Code Phone Number <br />9. Standard Industrial <br />Code for the Site:) -7 5 <br />DISC 1358 04/02/2003 Moi tL q ti <br />10,3 <br />r <br />