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0 <br /> State of California—California Environmental Protection Agency Department of Toxic Substances Control-GISS <br /> P.O.Box 806 <br /> Sacramento,CA 95812-0806 <br /> California Hazardous Waste Permanent II) 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.d[sc.ca. ov and click on Reports. <br /> New Number Requests. Check all that apply. (See instructions.) <br /> ❑ 1. I am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑Transporter <br /> Reason for new number: A. ❑ Never hada-number-B. ❑ Business moved C. 0 Legal owner of business changed <br /> If your business generates greater than 100 kg of RCRA hazardous waste per month, contact US EPA for a federal ID number. <br /> Chanties to Status or Information for an Existing ID Number. (See instructions) <br /> For existing ID number: C A L_ O b Q o.J_ '/ !tr L g <br /> ❑ 2. I am updating the mailing address and/or contact information only. <br /> LO 3. 1 am inactivating this ID Number. <br /> ❑ 4. 1 am reactivating this ID Number. <br /> ❑ 5. I am changing the business name. There has been no ownership change. <br /> (See instructions) <br /> 6. Site/Facility/Business Name(Include DBA): TOWER PARK RESORT <br /> 7. Site Location: 14900-W.HIGHWAY 12 <br /> Street <br /> LODI CA 95242-0000 SAN JAOQUIN <br /> City State Zip County <br /> 8.(a)Federal Employer ID Number: (b)Board of Equalization Fee Account Number: <br /> (b) is only required from generators ofgreater than 5 tons per calendar year.) <br /> (See instructions.) <br /> 9. Mailing Address: <br /> Street <br /> City State Zip <br /> (See instructions.) <br /> 10. Site Contact Person: STEVE BURTON <br /> First Name Last Name <br /> Contact Person Address: 14900-W.HIGHWAY 12 <br /> Street <br /> LODI CA 95242-0000 <br /> City State Zip <br /> Contact Person Phone Number: ( 09 ) 369-1041 Fax Number: ( 209) 369-1317 <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address: TPRegionPAOL.COM <br /> Preferred Primary Communication: ❑ Mail ❑ Email <br /> y / (NW instruc 'ons.) <br /> 11. Legal Business Owner(not property ownerJ•1(, 1"Pakra.,i0Name <br /> 4 <br /> / feo- 1 . /�iGr%u� /.2 ,[moo; <br /> Owner Address: 10A 95.242- Oona <br /> Street AV- City State Zip <br /> Owner Phone Number: Z( cl) 3 LZLq-) Fax Number: ( <br /> Area Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: _ (4-Digit Number) (See instructions.) <br /> DTSC Form 1358(7/06) www.dtsc.ca.gov <br />