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State of California—California Environmental Protection Agency Department of Toxic Substances Control -HWMP P.C.Box 806,Sacramento,CA 95812-0806 PERMANENT STATE 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.dtsL.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 other than those hazardous waste listed in 40 CFR 261.5 subparts(c)and(d),per month, complete Form 8700-12 for an EPA (federal)ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER 4ern tr For existing ID number: C A L 0 0 0 3 3 4 2 0 8 E7 2. 1 am updating the mailing address and/or contact information only. 3. 1 am inactivating this ID number. JUL 12 2016 p 4. 1 am reactivating this ID Number. ❑ 5. 1 am changing the business name only, no ownership change. ak► (See instructions.) s. site/Facility/Business Name(include DBA): B & G Group Inc. dba Fast Lane Central Vallev 7. Site Location: 116 E Roth Road Street Lathrop CA 95330 San Joaquin 9. Mailing Address: 111 Healdsburg Avenue (See instructions.) Street Healdsburq CA 95448 City State Zip 10. Site Contact Person: Hardeep Gill (See instructions.) First Name Last Name Contact Person Address: 111 Healdsburg Avenue Street Healdsburg CA 95448 City State Zip Contact Person Phone Number: (7o-i )431-3510 Fax Number: (707)395-4433 Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: hardeep(5)_bgrouglnC.Corl'I Preferred Primary Communication: ❑■ Mail ❑ Email (see instructions.) 11. Legal Business Owner(not property owner): Fast Lane Central Val ley LLC First Name Last Name Owner Address: 111 Healdsburg Avenue Street Healdsburq CA 95448 City State Zip Owner Phone Number: X707)431-3510 Fax Number: (707 )395-4433 Area Code Phone Number Area Code Fax Number (See instructions.) 12. Standard Industrial Classification(SIC)Code for the Site: 5 5 4 1 (4-Digit Number) (See instructions.) 13. Certification. l certify under penalty 3 law that the inf rmation on this document was prepared to the best of my knowledge and belief to be, true,accuratpa d cam Tete. SIGNATURE DATE July 12, 2016 NAME(print) HSE' p Gil-I" TITLE Operations Mgt'. PHONE 707-431-3510 DTSC 1358(5129115)