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• State of California - California Environmental Protection Agency Department of Toxic Substances Control - HWMP <br />P.O. Box 806, Sacramento, CA 95812-0806 <br />PERMANENT STATE ID NUMBER APPLICATION <br />Please type or neatly print in ink. Please review the line -by-line instructions carefully. <br />i o cnecK on one sums or your re ues[, go to :rrwww.nwrs.arsc.ca. ov ana cncK on ne arts. <br />NEW NUMBER REQUESTS Check all that apply. (See instructions.) <br />❑ 1. 1 am applying for a new permanent Califomia ID number as a hazardous waste: ❑ Generator ❑ Transporter <br />Reason for new number: A. ❑ Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed <br />If your business generates greater than 100 kg of RCRA hazardous waste other than those hazardous waste listed in 40 CFR 261.5 <br />subparts (c) and (d), per month, complete Form 8700-12 for an EPA (federal) ID number. <br />CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER (See instructions.) <br />For existing ID number: CA L 0 0 0 4 2 0 0 2 3 <br />2 2. 1 am updating the mailing address and/or contact information only. <br />❑ 3. 1 am inactivating this ID Number. <br />0 4. 1 am reactivating this ID Number. Reason (please select one): A. 2 Verification Questionnaire B. ❑ Other <br />5. 1 am changing the business name only, no ownership change. <br />Contact Person Phone Number:2( 09 ) 253-1589 Fax Number: ( <br />Area Code Phone Number Area Code Fax Number <br />Contact Person Business Email Address: marina@towerparkresort.com Preferred Primary Communication: ❑ Mail in Email <br />11. Legal Business Owner (not property owner): <br />STOCKTON DELTA RESORT LLC (See instructions.) <br />Owner Address: <br />401 HALL ST SW Name GRAND RAPIDS MI 49503 <br />Street City State Zip <br />Owner Phone Number: L209_) 369-1041 Fax Number: (� <br />Area Code Phone Number Area Code Fax Number <br />12. Standard Industrial Classification (SIC) Code for the Site: <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 and complete. <br />SIGNATURE DATE <br />NAME (print) JACK KORTUEM TITLE MARINA MANAGER PHONE (209) 283-1589 <br />