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r <br />State of California — California Environmental Protection Agency <br />Department of Toxic Substances Control - GISS <br />P.O. Box 806 <br />Sacramento, CA 95812-0806 <br />California Hazardous Waste Permanent ID Number Application <br />Please type or neatly print in ink. Please review the line-bv-line instnictions carefully. <br />To check on the status of your request, go to.www.hwts.dtsc.ca.gov and click on Reports. <br />New Number Requests. Check all that apply. (See instructions.) <br />❑ 1. I 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. ❑ Business moved C. ❑ 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 />Chances to Status or Information for an Existing ID Number. (See instnictions.) <br />For existing ID number: C A <br />❑ 2. I am updating the mailing address and/or contact information only. <br />❑ 3. I am inactivating this ID Number. <br />❑ 4. I am reactivating this ID Number. <br />❑ 5. I am changing the business name. There has been no ownership change. <br />6. Site/Facility/Business Name (Include DBA): <br />7. Site Location: <br />Street <br />City <br />8. (a) Federal Employer ID Number: <br />(See instructions.) <br />State Zip County <br />(b) Board of Equalization Fee Account Number:_ <br />is onlv required from generators ofgreater than S tons <br />calendar <br />(See instnictions) <br />9. Mailing Address: <br />Street <br />City State Zip <br />10. Site Contact Person: <br />Contact Person Address: <br />First Name <br />Street <br />City <br />Contact Person Phone Number: ( <br />Area Code <br />Contact Person Business Email Address: <br />Preferred Primary Communication: ❑ Mail <br />11. Legal Business Owner (not property owner): <br />Owner Address: <br />Street <br />Owner Phone Number: (_) _ <br />Area Code <br />(See instructions.) <br />Last Name <br />State Zip <br />Fax Number: (� <br />Phone Number Area Code Fax Number <br />❑ Email <br />(See instnictions.) <br />Name <br />City State Zip <br />Fax Number: ( ) <br />Phone Number Area Code Fax Number <br />12. Standard Industrial Classification (SIC) Code for the Site: _ _ _ _ (4 -Digit Number) (See instructions) <br />DTSC Form 1358 (7/06) www.dtsc.ca.gov <br />