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State of California — California Environmental Protection Agency <br />Department of Toxic Substances Control <br />GISS <br />P.O. Box 806 <br />Sacramento, CA 95812-0806 <br />California Hazardous Waste Permanent ID Number Application <br />Please review the line -by-line instructions carefully. <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: JK Generator ❑ Transporter <br />Reason for new number: A. ❑ Never had a number B. ❑ Business moved C. K Legal owner of business changed <br />Chanties to Status or Information. (See instructions.) <br />For ID number: C A <br />XI 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. This site is a: ❑ Generator of less than 1,000 kg/month California -only waste (See instructions.) <br />❑ Generator of greater than 1,000 kg/month California -only waste <br />❑ Conditionally Exempt Small Quantity Generator of RCRA Waste <br />7. Site/Facility Name: Eugenia Val dPz dlia T h T Marker <br />8. Site Location: 8125 S. El Dorado St. <br />Street <br />French Camp Ca_ 95231 San Joaquin <br />City State Zip County <br />9. Mailing Address: P.O. Box 238 (See insiructions.) <br />Street <br />French Camp Ca. 95231 <br />City State Zip <br />(See instructions.) <br />10. Site Contact Person: Eugenia Valdez <br />First Name Last Name <br />Contact Person Address: 1830 S. San Joaquin St <br />Street <br />Stockton Ca. 95206 <br />City State Zip <br />Contact Person Phone Number: 209 815-3062 Fax Number: (209) 982-0912 <br />Area Code Phone Number Area Code Fax Number <br />Contact Person Business Email Address: 1830 S. San Joaquin St. Stkn, Ca. 95206 <br />Preferred Primary Communication: Mail ❑ Email <br />11. Legal Business Owner (not property owner): Eugenia Valdez <br />Name <br />(See instructions.) <br />Owner Address: 8125 S. E1 Dorado St. French Camp Ca. 95231 <br />Street City State Zip <br />Owner Phone Number: 20 982-0897 <br />Area Code Phone Number <br />12. Standard Industrial Classification (SIC) Code for the Site: 5 5 4 1 (4 -Digit Number) (See instructions.) <br />DTSC Form 1358 (9/04) <br />