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State of California—California Environmental Protection Agency Department of Toxic Substances Control-GISS P.O.Box 806,Sacramento,CA 95812-0806 - Print 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 reguest,go to www.hwts.dtsc.ca. ov and click on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) V1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑Transporter Reason for new number: A. aNever 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 for a 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. / y�,,/ 9 J/� � � (See instructions.) 6. Site/Facility/Business Name /(include DBA): Tide /!/E'W '97, 7ac�(�dKJ �� 7. Site Location: 7��f/Il , 150 , J City State Zip County 8.(a)Federal Employer ID Number (b) Board of Equalization Fee Account Number ((b)is only required from generators of greater than 5 tons per calendar year.) �U( 3 Y� (See Instructions.) 9. Mailing Address: rrere��• r City State Zip / Al C�71 (See instructions.) 10. Site Contact Person: �I/ First Last Name Contact Person Address: 4"o `��A1G'a<vc City ////�� Staatte Zip`, Contact Person Phone Number: �/li —�AlFax Number: 2, Area Code Phone Number Area Coe Fax Number Contact Person Business Email Address: Preferred Primary Communication:E]Mail ❑Email (' y� (See instructions.) 11. Legal Business Owner(not property owner):/Y K' 7 � r0� � � Name Owner Address:1 r V 0/�d D� __ ao!0 St reet 1".�- �� City ' State 0 Owner Phone Number: �� ) 7rs � Fax Number: (,�)�'.l. ��J�7�� Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification (SIC) Code for the Site: _ _ (4-Digit Number) (See instructions.) 13. Certification: I certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to b ue, accurate and omplete. SIGNATURE�/�// DATE NAME(print)W/VA� y y / X�C if TITLEa—A— e-44_ PHONFa09 ��/Z DTSC Form 1358(6/08)