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State of California-California Environmenrai Protection Agency <br /> - Department of Toxic Substances Control-GISS <br /> Rgse ',Forrn' ,• P.O.Box 806,Sacramento,CA 95812-0806 <br /> I CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APP <br /> Please type or neatly print in Ink. Please review the line-by-Ilne instructions carefully, LIGATION <br /> To check on the status of our re uest, o to www.hwts.dtsc.ca. ov and click on Reports. <br /> ENEWNUMBEIR REQUESTS Check all that apply. <br /> plying for a new permanent California ID number as a hazardous waste: M Generator ❑TransporteBeInstnict�ons.) <br /> r new number. A. 2Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed <br /> s generates greater than 100 kg of RCRA hazardous waste per month, contact US EPA for a federal ID number. <br /> F <br /> ANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER <br /> existing ID number C A _ _ e instructions.) <br /> 2. 1 am updating the mailing address and/or contact information only.3. 1 am inactivating this ID Number. <br /> ❑ 4. I am reactivating this ID Number. <br /> ❑ 5. 1 am changing the business name only, no ownership change. MAR Q 6 2009 <br /> U1 V <br /> 6. Siteiracility/Business Name(Include DBA): R <br /> NEAL( r tans.) <br /> > <br /> 7. Site Location: - Z'Z\ <br /> S eet <br /> City <br /> 8. (a) Federal Employer ID Number_ State zip County <br /> Board of Equalization Fee Account Number <br /> only required from generators of greater than 5 tons per calendar year.) <br /> 9. Mailing Address: _ V� G • ' \>.�x 9,P, (See instructions.) <br /> Street <br /> `Q Z 4 <br /> State Zip <br /> 10. Site Contact Person: (See instructions) <br /> First Name Last Name <br /> Contact Person Address: <br /> Street <br /> City <br /> State <br /> Zip <br /> Contact Person Phone Number: ( N pC\(Z4 <br /> Fax Number: CaLS) L Q._ c� k12"-?- <br /> de <br /> Area CoPhone Number <br /> Area Code Fax Number <br /> Contact Person Business Email Address: Vo <br /> Preferred Primary Communication:®Mail ❑Email <br /> 11. Legal Business Owner(not property owner): (See instructions.) <br /> Owner Address: `, Name <br /> Street <br /> Owner Phone Number: City State Zip <br /> Fax Number. <br /> Area Code Phone Number Area Code Fax Number <br /> 112. Standard Industrial Classification(SIC)Code for th�Siitee.' U \ <br /> — _ --�t (4-Digit Number) (See instructions.) <br /> 13. Certification: /certify under penalty of law that the information on this document was prepared to the best of my <br /> belief to be,true,accurate and complefe knowledge and <br /> SIGNATURE \ <br /> _—� j DATE <br /> NAME(print) ���w� C��� - '� �R TITLE_ w laGy <br /> PHONE�ZO�� — 13 <br /> DTSC Form 1358(6/08) <br />