COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

State of California—California Environment -otection Agency Department of Toxic Substances Control-GISS Reset Form P.O. Box 806,Sacramento,CA 95812-0806 Print 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.hwts.dtsc.ca.gov and click on Reports. 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 ❑Transporter Reason for new number: A. ❑ Never had a number B. ❑ 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 for a federal ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) For existing I D number: C A T 0 0 0 6 1 0 9 4 9 ❑ 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. Temple Inland (See instructions.) 6. Site/Facility/Business Name(Include DBA): Tem p 7. Site Location: 400 W. Valpico Road Street Tracy CA 95376 S4Vj60W1A1 City State Zip County 8. (a) Federal Employer ID Number Board of Equalization Fee Account Number 36-061696 ((b)is only required from generators of greater than 5 tons per calendar year.) Ico Road (See instructions.) 400 W. Val 9. Mailing Address: P Street Tracy CA 95376 City State Zip 10. Site Contact Person: Jim Dacayanan (See instructions.) First Name Last Name Contact Person Address: 400 W. Valpico Road Street Tracy CA 95376 City State Zip Contact Person Phone Number: 2( O9 ) 836-6181 Fax Number: 2( O9 ) 836-6160 Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: lim.dacayanan@ipaper.com Preferred Primary Communication: [—]Mail ❑✓ Email TIN INC dba International Paper (See instructions.) 11. Legal Business Owner(not property owner): p Name Owner Address: 1300 So. Mopac Exom Austin TX 78746 Street City State Zip Owner Phone Number: 5( 12 ) 434-5800 Fax Number: (� Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification (SIC) Code for the Site: 2 6 5 3 (4-Digit Number) (See instructions.) 13. Certification: /certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to be, true, qcwrate al complete. SIGNATURE DATE NAME(print) �/L,L l✓�S TITLE G&�PO/Z- PHONE 201 DTSC Form 1358(6/08)