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State of California-California Environmental Protectlon Agency Department of Toxic Substances Control-GISS p. P.O.Box 806,Sacramento,CA 85812-0806 CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or neatly print In Ink. Please review the lino-by-line Instructions carefully. To check on the status of your request o to w,hwla.d c. ov and dick 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: (Generator []Transporter Reason for new number: A. ❑Never had a number B�Business moved CC..'❑Legal owner of business changed If your business generates greater than 100 kg of RCRA haze ous waste permonth, contact US EPA fore federal ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) For existing ID number: C A ,A— QP— Q L 6 '6L -L- 2. 2, I am updating the mailing address and/or contact information only. 3. 1 am Inactivating this ID Number. ❑ 4. 1 am reactivating this liD Number. ❑ 5. 1 am changing the business name only,no ownership change. 6. Slte/FaGlltyl(3uslness Name(include DBA): T r�,P!*� � �,�an�:o� C�, (See Instructions.) 7. Site Location: g4ero Cd. .+4,rbo e- Street Tia c v CA City State Zip County 8.(a)Federal Employer ID Number 94 311 70LO (b).Board of Equalization Fee Account Number n ((b)is only required from generators of greater then 5 tons per calendar year) 9, Mailing Address: T" ba XI '1100 (See Instructions.) Str©tl �F�d r4 City State Zip I (See instructions.) 10. Site Contac!Person: Fc rht�•o�> S a-�s First Name Last Name Contact Person Address: g4'40 4 r.dar- 4,e-- sbvet r�Ae.v �� gS3iy City 7— State Zip Contact Person Phone Number: [L61) ` SDS Fax Number: ( 0 SO(�d Area Code Phone Number Aroa Code Fax Number Contact Person Business Email Address VAP 411 or.�&VPMPAOW Preferred PrlmeryCommunlcallon: all ❑Ernail e / 11. Legal Business Owner plot property owner):. 7r rp 4- �' I�F..w..,r,� C.�, (See Instructions,) Owner Address: QGX 0.r4Name►� Q�k( P °�yf•O J Street Clty Slste ZD Owner Phone Number: (1 Zs 9455 — 9.4ya Fax Number. t =%j— 964 — 9$d Z_ Area Code Phone Number Area Coda Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: _ (4-Dlglt Number (see instructions.) 13, Certification: I certify under penalty of law that the Information on this document was prepared to the best ormy knowledge and belief to be, true, a urate and complete. SIGNATURE DATE NAME(print)-Dov �oav TITLE GGKa.ytl /�1a►«...,. PHONE qtS fr44 -9'gpd DTSC Fonn 1358(8108) =— t7'd M72139t7:01 )------090SSz860Z i, AdMd)l00Zil 7-dONU1 ,:W0ad dTO:20 OT02-22-d3S