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State 01 Cawfomia-Cavtornla Etiviron Abacuo,Agency W panmant of Toxic Substances Control-GiSS <br /> r.O,Box&16,Sacramento.CA 96812-08M <br /> CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br /> Please type or neatly print in ink. Plesse review the Ane-by-line instructions carefully. <br /> To check on the status of your requem,go to and click m Reports. <br /> NEW NUTASER REQUESTS Check ON that apply. (See instructions.) <br /> 1. ram applying We new pormanant Cakfomia rO number as a hazardous waste: Q Generator OTransporter <br /> Reason for new number A. nn Never had a number B. 0 Business moved C. Legal owner of business changed <br /> It your business generates greater Man t OD k of RCRA hazardous waste per aped <br /> month, cUS EPA for a federal ID number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (509 ff X0Vr& s) <br /> For existing ID number. C A L .Q -a -A -2� -Z- X- <br /> L <br /> o 2. 1 am updating the mailing address and/or contact inionnation only. <br /> © 3. 1 am inactivating this ID Number. <br /> 5L 4. 1 am remotivating this ID Number. <br /> 0 5. 1 am changing the business name only, no ownership change. <br /> fSes insbvctions.) <br /> B. Site/FacildytBusiness Name(Include DBA): T n 5 c r v r rr.e S /o h l h c <br /> 7. Site Location: 10 1 '& i,\)r, 4 Irl 0+ C7 vo VC- ad <br /> Street SC 6 <br /> 1 11'r '�S9 I N �� � SG N ,J�OR q V!V7 <br /> City State Zip County <br /> B.(a)Federal Employer ID Number Board of Equalization Fee Account Number` <br /> b a only required from generators of greater than 5 tons Per calendar year-) <br /> r� (See insUuchons.) <br /> 9. Mailing Address: P C U = d G X 8 79 <br /> Street <br /> City ,,.r^State Zip <br /> 10. Site Contact Person: /V/q 5) r r 1-R I/V (See insbuctlon&) <br /> First Name Last Name <br /> Contact person Address: P - D Q 7 <br /> street t� or o N Cfr 9SL �6 <br /> city State zip <br /> Contact Person Phone Number. (Z09t 7 *� `) - 'S 9 9 3 Fax Number. 20 <br /> Area Code Ph"the mbar Area Code Fax Number <br /> Contact Person Business Email Address: Preferred Primary Cammunicalion:gMad ❑Emall <br /> (Sea fns6ucfions.) <br /> 11. Lagar Business Owner(not "property owner): T r1 S(�t y� <br /> Name / ar Un C�- `SSL <br /> Owner Address: �6 n �Ct in 7,-1- C ro✓`c �G7 rl <br /> Sb,W City side zip <br /> Owner Phone Number: (2o q) 7 9 y-'$ y'9 3 Fax Number. <br /> Aras Code Phone Number Area Cpde Fax Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: u I (44vt Number) (See instruciians.) <br /> 13. Car0catlon: f caArTy under penalty of taw fftet Me mformatnon on this document was prepared to Me best of my knowledge and <br /> beAW to be,We,accurate and complete. <br /> _/� i <br /> SIGNATURE 3' �GC,�w+�/ //tir'�7 DATE <br /> NAME(print) �,/R-�.r' Ge-r '/A- t? rn. TITLE ri14. 4.rr. . PNoNF� 'kz , 79G/r- '9'93 <br /> DTSC Form 13M(&U8) <br />