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State of California - California Environmental Protection Agency Department of Toxic Substances Control <br />P.O. Box 806 <br />Sacramento, CA 95312-0806 <br />California Hazardous Waste Permanent ID Number Application <br />Please review the line -by-line instructions carefully and complete all items on the application. <br />Ne 'umber Re nests. Check all that apply. (See instructions) applying for a new permanent California ID number as a: enerator [ ] Transporter <br />Reason for new number: A. [ ] Never had a number B. [ ] Business moved C. [ i Legal owner of business changed <br />Chances to Status or Information. (See instructions.) <br />For ID number: C A _ _ _ _ _ _ _ <br />[ ] 2. I am updating the mailing address and/or contact information only. <br />[ ] 3, t am inactivating this ID Number. <br />[ ] 4. 1 am reactivating this ID Number. <br />[ ] 5. 1 am changing the business name. There has been no ownership change. <br />6. This site is a: [ ] Conditionally Exempt Small Quantity Generator of RCRA Waste (See instructions) <br />Generator of less than 1,000 kg/month California -only waste <br />[ ] Generator of greater than 1,0�00/kg/month California -only waste <br />7. Site(Facility Name: <br />8. Site Location: ' ` S� {2 w`t `? ZZ <br />9t (See instructions.) <br />9 Mailing Address rg �j/ <br />VAC6City tate Zip <br />(See instructions) <br />10. Site Contact Person: <br />Fir Nam 1 O Last <br />Contact Person Address: & _9ia�t <br />City State Zip G <br />Contact Person Phone Number: (?0 q � Fax Number: aq <br />Area Code Phone Number Area Code Fax Number <br />Contact Person Business Email <br />Preferred Primary Communical <br />(See instructions.) <br />11. Legal Business Owner (not property owner): <br />Name <br />Owner Address: V96 + <br />S 93/— l�g ity Stale Zip <br />Owner Phone Number:: torp <br />Area Code Phone Number <br />12. Standard Industrial Classification (SIC) Code for the Site: (4 -Digit Number) (See instructions) <br />DTSC 1358 10/03 <br />