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,%W ..i <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 ID 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 dtcc ca gov and click on Reports <br />New Number Requests. Check all that apply. (See instructions) <br />❑ 1. I 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 />Ifyour business generates greater than 100 kg of RCRA hazardous waste per month, contact US EPA for a federal ID number. <br />Chanees to Status or Information for an Existine ID Number. (See instructions) <br />For existing ID number: C A_ <br />❑ 2. 1 am updating the mailing address and/or contact information only. <br />❑ 3. I am inactivating this ID Number. <br />❑ 4. I am reactivating this ID Number. <br />❑ 5. 1 am changing the business name. There has been no ownership change. <br />(See instructions) <br />6. Site/Facility/Business Name (Include DBA): <br />7. Site Location: <br />Street <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 <br />(See instructions) <br />9. Mailing Address: <br />Street <br />City State Zip <br />(See instructions) <br />10. Site Contact Person: <br />First Name Last Name <br />Contact Person Address: <br />Street <br />City State Zip <br />Contact Person Phone Number: Fax Number: () <br />Area Code Phone Number Area Code Fax Number <br />Contact Person Business Email Address: <br />Preferred Primary Communication: ❑ Mail ❑ Email <br />(See instructions) <br />11. Legal Business Owner (not property owner): <br />Name <br />Owner Address: <br />Street City State Zip <br />Owner Phone Number: Fax Number: C ) <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 />