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State of California-California Environmental Protection Agency Department of Toxic Substances Control•GISS '1Rtaf�t Form .P.O.Box 808,Sacramento,CA 95812-0808 CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or neatly print in Ink. Please review the tine-by-line instructions carefully. To check on the status of your request,goto wwwhwtsdtsc.ca.00v and click on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) 1. 1 am applying for a now permanent California ID number as a hazardous waste: ❑ Generator Transporter Reason for new number. A. 11 Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed If your business generates greeter an 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 ID number. C A L 0 0 0 2 8 2 5 0 1 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. 8. Si1e/FacilityBusiness Name(Induce DBA): West Lane Valero (See instructions.) 7. Site Location: 9484 West Lane Street CA 95210 United States Stockton city state Zip County 8. (a)Federal Employer ID Number Board of Equalization Fee Account Number ((b)is only required from generators of greater than 5 tons per calendar year.) (See instructions.) 9. Mailing Address: 9484 West Lane Street Stockton CA 95210 city State Zi 10. Site Contact Person: Diana Phan (See instructions.) First Name Last Name Contact Person Address: 9484 West Lane Street Stockton CA 95210 city slaw zip Contact Person Phone Number. 2( 09 ) 993-7830 Fax Number. (� Area Code Phone Number Ma Code Fax Number Contact Person Business Email Address: DlanathanhQyahoo.com prollarrod Ply Commonloation:OMail [Zl Emall (See instructions.) 11. Legal Business Owner(not property owner): Diana Phan Name Owner address: 9484 West Lane Stockton CA 95210 Street city state Do Owner Plane Number: ( 209 ) 993-7830 Fax Number. (� Area Code Phone Number Area Coda Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: 4 7 1 9 (4-Digit Number) (See instructions.) 13. Certification: 1 certify under penalty of law that Me information on this document was prepared to the best of my knowledge and belief to be, true, accurate and complete. SIGNATURE L � • .1 DATE La 1,f-• ,,40 V- 0 NAME (print) 'DI A-w )A TITLE r2 t `fj e-r PHONE0,2-oq- q q3-?A 3 n DTSC Form 1358(8108)