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11/06/2007 15 :32 FAX M""' 116 <br /> lxpmsment of Toxic Substances Control-GISS <br /> Stere of California–California Environmental Pr t on A6eacy P.O.Box 806 <br /> Sacramento,CA 95812-08116 <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_r!q_u_S_8_t, o to w hwts.dm . ov and click on R orfs. <br /> (See instructions.) <br /> New Number Requests. Check all that apply. <br /> ❑ 1. I am applying for a new avant California 1D number as a hazardous waste: ❑ C�enemtor ❑Transporter <br /> Reason for new number. A Lever had a number B. ❑ Business moved C. %/Legal owner of business changed <br /> yyoar business generates greater than 1.00 1g of RCRA hazardous waste per month,contact US EPA for a federal ID munber. <br /> C ea m 5ltsms or information for en xlsdna ID umber. (See lnrtnrctions.) <br /> For existing ID number. C Al — _ _ — — — — — — — <br /> ❑ 2. 1 am updating the mailing address and/or contact information only. <br /> ❑ 3. 1 am inactivating this ID Number. <br /> p 4, I am reactivating this ID Number. <br /> ❑ 5_ t am changing the business name. There has been no ownership chattge. <br /> 1 A' (See Instructions.) <br /> 6, Site/Facility/Business Name(Include DBA): V Y <br /> 7. Site Location <br /> She t /a <br /> Arl <br /> City State _/zip County <br /> 8.(a)Federal Employer ID Number._)— Board of Equalization Fee Account Number: <br /> (b)is only required from#yn2ytors ofgrrater than S tors per calendar year.) <br /> (See instructions.) <br /> 9. Mailing Address: � Q' <br /> Cit State Zi <br /> (See instructions.) <br /> 10. Site Contact Person: U I <br /> First Name �N <br /> Contact Person Address: np r <br /> S <br /> City /�p�r� /State Zip <br /> Contact Person Phone Number; (� "�i — Fax Number: <br /> Arca Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address—� <br /> Preferred Primary Communicat on: ❑ Mail ❑ Email <br /> c (See instructions) <br /> 11. Legal Business Ownert�ag <br /> rty owner): <br /> Name <br /> Owner Address: j <br /> Scity OW/e D Z <br /> Zin <br /> Owner Phone Number � Fax Number: NL <br /> Area Cade Phone Number Cade Fax Ntnnher <br /> 12, Standard Industrial Classification(SIC)Code for the Site: _ _ _ (4-Digit Number) (See instruct(ons-) <br /> DTSC Form 1358(7/06) _ w Atsc.ca.gov <br />