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State of California-California Environmental Protection Agency department of Toxic Substances Control-GISS Reset Form Print P.O.Box 806,Sacramento,CA 95812-0806 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.hw[s.dtsc.ca, ov and click on Re orts. NEW NUMBER REQUESTS Check all that apply. (See instructions.) 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator FlTransporter Reason for new number: A. ❑ Never had a number B. El Business moved C. ❑ Legal owner of business changed If your business generates greater than 100 kg of RCRA hazardous waste per month, contact US EPA fora federal ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTIN ID NUMBER (See instructions.) For existing ID number: CA L D 0 -0 . ;S1 6 2 2. 1 am updating the mailing address and/or contact information only. 3. 1 am inactivating this ID Number. ® 4. 1 am reactivating this ID Number. ❑ 5. 1 am changing the business name only, no ownership change. 6. Sfte/Facility/Business Name(include DBA): Mc.LA^/a, CO, (See instructions.) 7. Site Location: goo C"wr /&<e� Ae& A✓e• Street q/f-cti/ �I53 >� fiw✓ o�ayv Board of Equalization Fee Account Number ((b)is only required from generators of greater than 5 tons per calendar year) 9. Mailing Address: �QO 165/1/ Joe 5e"lAE/20 /A-y . (See instructions.) Street CA '953C4 � y City Slate Zip (See instructions.) 10. Site Contact Person: fji2uC% 09124J10 First Name Last Name Contact Person Address: ?00 ex f:7 � q�c+�1P� f�✓� Stree ,4LU City State Zip Contact Person Phone Number. (ZJC/ ) ZZ/ - 75z{ Fax Number: 22/ - 7_6 9?R Area Code Phone Number Area Code Fax Number Contact Person Business Email Address:459Preferted Primary Communication: Mail 0,Email 11. Legal Business Owner(not property owner): 1-4 d Z44-_1Fi o (See instructions.) Name PHVZkw %/.N "e i� / 76So 3 Owner Address: z/7�7 /UfPGi'ftr�s- i4r� � Jc Street City State Zip Owner Phone Number: Z( ai 7'fZ 51161 Fax Number: (Z� 7114-2, ;V 9 g Area Code Phone Number lArea Code Fax Number T� 12. Standard Industrial Classification(SIC)Code for the Site: / 9 (4-Digit Number) (See instructions.) 13. Certification: I certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to be, true,accurate and complete. - SIGNATURE_ - DATE lU/8/0 NAME(print) /7lr2vLc/ /�- L021�-✓Cl TITLE�lS72/Pitr `r�'a PHO�22-/- 75"i-'<2 DTSC Form 1358(6/08)