Laserfiche WebLink
09/25/2008 THU 12:07 FAX 2094683433 SJC EHD 2001 <br /> ********************* <br /> *** FAX TX REPORT *** <br /> ********************* <br /> TRANSMISSION OK <br /> JOB NO. 1863 <br /> DESTINATION ADDRESS 919162554703 <br /> PSWD/SUBADDRESS <br /> DESTINATION ID <br /> ST. TIME 09/25 12: 06 <br /> USAGE T 00' 25 <br /> PGS. 1 <br /> RESULT OK <br /> State of California-California Environmental Protection Agency Department of Toxic Substances Control-GISS <br /> Reset Form <br /> P.O.Box 806,Sacramento,CA 95812-0806 <br /> Print <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 request,go to www-hwts.dtsc.ca.cLov and click on Reports. <br /> NEW NUMBER REQUESTS Check all that apply. (See instructions.) <br /> 1. 1 am applying for a new permanent California ID number as a hazardous waste: )� Generator ❑Transporter <br /> Reason for new number: A. [ Never had a number B. E] Business moved C. E]Legal owner of business changed <br /> If your business generates greater than 100 kg of RCRA hazardous waste per month,contact US EPA for a federal ID number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) <br /> For existing ID number. C A <br /> ❑ 2. 1 am updating the mailing address and/or contact information only. <br /> ❑ 3. 1 am inactivating this ID Number. <br /> ❑ 4. 1 am reactivating this ID Number. <br /> ❑ 5. 1 am changing the business name only,no ownership change. <br /> (See instructions.) <br /> 6. Site/Facility/Business Name DBA): 'L\-c� t O G1 S — <br /> 7. Site Location: b 61 , <br /> Street <br /> City <br /> <br /> )is only required from generators of greater than 5 tons per calendar year.) <br /> /c� (See instructions.) <br /> 9. Mailing Address: � U P o � � �C, � <br /> Street <br /> City State Zip <br /> (See instructions.) <br /> 10. Site Contact Person: `� `� `'C <br /> First Name Last Nam <br /> Contact Person Address: 2) bl <br /> Street <br /> C-�`2 L(, C+ <br /> City State Zip <br /> Contact Person Phone Number. (C� (C,) C�l�� ^S 7 Z�i Fax Number: ( ) <br /> Area Code Phone Number Area Code Fax Number <br /> �\o\_- C �,.�„ <br /> Contact Person Business Email Address: r\tel �����n , Preferred Primary Communication:[:]Mail ail <br /> (See instructions.) <br /> 11. Legal Business Owner(not property owner): ��� ° ��f!, <br /> Name <br /> Owner Address: d9") F - \1 <br /> Nac `�-F"-\n C �� �( ��?. 14 C <br /> StreetCity Stat Zio <br /> Owner Phone Number: (`C(G) �� -77 � 's _Fax Number: ( '7 - C ( � Z <br />