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State of California—California Environmer rotection Agency Department of Toxic Substances Control-GISS Reset FormlI 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.cL.gov 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: Z Generator [I Transporter Reason for new number: A. ❑✓ Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed If your business generates greater than 100 kg of RCRA hazardous waste per month, contact US EPA fora 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. (See instructions.) 6. Site/Facility/Business Name(Include DBA): LMB International 7. Site Location: 1636 E. Alpine Ave. - Street CA 95205 San Joaquin Stockton City State Zip County 8. (a) Federal Employer ID Number 30-0738455 . Board of Equalization Fee Account Number ((b)is only required from generators of greater than 5 tons per calendar year.) (See instructions.) 9. Mailing Address: P. O. Box 8892 Street Stockton CA 95208 City State Zip 10. Site Contact Person: Denise Voll (See instructions.) First Name Last Name Contact Person Address: 1636 E. Alpine Ave. Street Stockton CA 95205 City State Zip Contact Person Phone Number: 2( 09 ) 546-1704 Fax Number: 2( O9 ) 546-1703 Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: denise@lanemasters.com Preferred Primary Communication: ❑Mail ❑✓ Email (See instructions.) 11. Legal Business Owner(not property owner): Barry K Fyffe Name Owner Address: 6949 13th St. Sacramento CA 95831 Street City State Zip Owner Phone Number: 9( 16 ) 715-7708 Fax Number: 9f 16 ) 392-2125 Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification (SIC) Code for the Site: 2 8 4 2 (4-Digit Number) (See instructions.) 13. Certification: 1 certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to be, true, accurate and complete. SIGNATUREy � DATE p J NAME (print) Dep f.5& VOTITLE, PHONE � ��✓ l`v. it/ DTSC Form 1358(04/12)