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State of California—California Environmental Protection Agency Depamment of Toxie Substown Control-G64S <br /> P.O.Box 806 <br /> Sacramento,CA 95812-OM <br /> California Hazardous Waste Permanent ID Number Application <br /> Please type or neafty print In ink. Please review the lure-by-line instructions carefully. <br /> To check on the status of Your Muest,go to mmjLwk.dtscca.,&gv and click on Reports. <br /> New Number Requests. Check all that apply. (See Instructions.) <br /> I. I am applying for anew permanent California ID number as a hazardous waste: ❑ Generator O Transporter <br /> Reason for new number: A. ❑ Never had a number B. ❑ Business moved C. A Legal owner of business changed <br /> If our business generates greater than 100 Ag of RCRA haaardous waste per month,contact US EPA for a,federal TO number. <br /> Changes to Status or Information for an Existing 10 Number, (See instructions) <br /> For existing ID number. CC A _ _ _ _ _ _ _ _ <br /> ❑ 2. I am updating the malling address and/or contact information only. <br /> ❑ 3. I am inactivating this ID Number. <br /> M 4. 1 am reactivating this ID Number. <br /> Cl 5. I am changing the business name. There has been no ownership change. <br /> i y, n ee instructions.) <br /> 6. Site/Facii tyBusiness fNaa�me(Include DBA): Gu 7j'Vyi r)S A u 1�/ KP�� I K <br /> 7. Site Location: 103-1 L VX)r--M 1 TE AVU� <br /> Street CA 0'5337 aQn .t=win <br /> City State Zip County <br /> 8.(a)Federal Employer ID Number: (b)Board of Equalization Fee Account Numbers 1U-lE 1 Ci^, q <br /> (b)Is only required from generators of8reafer than S tons per calendar year.) <br /> (See fnstructtons.) <br /> 9. Mailing Address: 1031 <br /> &A/PtfState ECA CA /1'-33.3- <br /> (See instructions.) <br /> I0. Site Contact Person: it 46=1 <br /> F Name tName <br /> Contact Person Address: 1 6._UC21C1 61,E. <br /> Street <br /> Y�1v�-feu�, GH <br /> city State Zip <br /> Contact Person Phone Number: (2.0 �2'34- 2.5le7' Fax Number: (_) <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address: lV'111C'�y 1 f1r 1 C� f*"k�j'Y1C�JL. beryl <br /> Preferred Primary Communication; WMail ❑ Email <br /> p (See instructions.) <br /> 11. Legal Business Owner(not property owner): <br /> Name /�� � <br /> OwnerAddress: h�tJ �'1 ! Y 6mm� CACA L "7 <br /> City State Zip <br /> Owner Phone Number Fax Number: (=)' <br /> Area Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: (4-Digit Number) (See Instructions.) <br /> DTSC Form 1358(7/06) www dtse cagov <br />