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State of California—California Environmenta,. .itection Agency jepartment of Toxic Substances Control-GISS Reset F0 I Print P.O.Box 806,Sacramento,CA 95812-0806 CALIFORNIA HAZARDOUS WASTE PERMANENT 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.dtsc.ca. ov 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: )Q Generator ❑Transporter Reason for new number: A. � Never had a number B. ❑ Business moved C. E] Legal owner of business changed If your business generates greater than 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 ❑ 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. r_ (See instructions.) 6. Site/Facility/Business Name(Include DBA): C'—�1 ` O v\ S 7. Site Location: G 0'r� f% E Street" � \ \ C 1� S. y G City _ State Zip County 1 O 0 p-71 8. (a)Federal Employer ID Number b �(b)Board of Equalization Fee Account NumberI — ((b)is only required from generators of greater than 5 tons per calendar year.) 9. Mailing Address: C� G L�4 (See instructions.) / Street L fN c,,S�- City State Zip (See instructions.) 10. Site Contact Person: k. �'C First Name Last Nam Contact Person Address: Street City State �D Zip Contact Person Phone Number: (� G' (�Z)2 ^S -7ZL Fax Number: ( ) ! �'�� ^ c �S , Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: C `r\ _ Preferred Primary Communication:Q Mail ail ^� ^ -7sC (See instructions.) 11. Legal Business Owner(not property owner): t � Name Owner Address: . �' \ Street / City Stat ZiD Owner Phone Number: ( G �� —��7` Fax Number. ( fl — C S� Z Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: _ (4-Digit Number) (See instructions.) 13. Certification: I certify under p n Ity of law that the information on this document was prepared to the best of my knowledge and belief to be, true,accurate a mplete. SIGNATURE �� r DATE �� •��/�� NAME(print) c•_. TITLE (k W rO�� PHONE C( 16 ^ DTSC Form 1358(6/08) Wer. �I 901 (6q-OIs3