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State of California-California Environmental Protection Agency Department of Toxic Substances Control <br /> P.O.Box 806 <br /> Sacramento,CA 95812-0806 <br /> California Hazardous Waste Permanent Ill Number Application <br /> Please review the line-by-line instructions carefully and complete all i[enis on the application. <br /> New Number Requests. Check all that apply. (See instructions.) <br /> I. 1 am applying for a new permanent California ID number as a: Generator [] Transporter <br /> Reason for new number: A. X Never had a number B. [] &Uiness moved C. [] Legal owner of business changed <br /> Changes to Status or Information. (See instructions.) <br /> For 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. There has been no ownership change. <br /> 6. This site is a: [] Conditionally Exempt Small Quantity Generator of RCRA Waste (,See instructions.) <br /> [� Generator of less than 1,000 kg/month California-only waste <br /> [] Generator of greater than 1,000 kg/month California-only waste <br /> A/ mA- <br /> 7. Site/Facility Name: I <br /> po g 6e/ Vi e- <br /> 8. Site Location: 77 7 S C_- <br /> ca i'v�po (' c'1'_'�dc-0 <br /> City State Zip County <br /> ��� (.See instructions)9. Mailing Address: <br /> CU IfIQ <br /> City State Zip <br /> (See instructions.) <br /> 10. Site Contact Person: ftp <br /> Mlall <br /> Ej t Nam Last Nan <br /> Contact Person Address: d <br /> Str tcalr�CJ <br /> /1 <br /> City State (� Zip <br /> Contact Person Phone Number: ( 3 ` �q Fax Number: <br /> Area Code PhoneNuqq��ber Area Code Fax Number <br /> Contact Person Busingss Email Address:�M0fj1 oD QInZ `C,0M <br /> Preferred Primary Communication: [] Mail [if Email <br /> � <br /> /� instruc[ions.) <br /> 11. Legal Business Owner <br /> f not property owner): 1 1 1f c t Q� �• <br /> Owner Address: a)V.A <br /> sL1 / V L1e „ U V �`► <br /> Street City State Zip gg[�aic) <br /> Owner Phone Number: (0 <br /> Area Code Phone Number <br /> 12. Standard Indu�trial Classificalion(SIC)Code for the Site: d (4-Digit Number) (.See instructions.) <br /> DTSC 1358 10/03 <br />