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State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> Office of Environmental Information Management <br /> PERMANENT STATE ID NUMBER APPLICATION <br /> Please type or print legibly in ink. <br /> NEW NUMBER REQUESTS Check all that apply. <br /> ❑ 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑ Transporter <br /> Reason for a new number: A. ❑ Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed <br /> If your business generates greater than 100 kg of RCRA hazardous waste other than those hazardous waste listed in 40 CFR 261.5 <br /> subparts(c)and(d)per month,please complete Form 8700-12 for a federal EPA ID number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER <br /> For existing ID number: C A _ 0 0 0 4 0 4 1 1 2 <br /> ❑ 2. 1 am updating the mailing address and/or contact information only. <br /> ❑ 3. 1 am inactivating this ID number. <br /> IJ 4. 1 am reactivating this ID number. Reason (please select one): A. ❑ Verification Questionnaire B. ❑ Other <br /> ❑ 5. 1 am changing the business name only. no ownership change. <br /> 6. Site/Facility/Business Name(include DBA): RIG MASTER TRUCK REPAIR INC <br /> 7. Site Location: 16300 MCKINLEY AVE <br /> LAf1rTKOP CA 95330 San Joaquin <br /> City State Zip Code County <br /> 8.(a) Federal Employer ID Number47-2917573 (b)CDTFAAccount Number <br /> ((b)is only required from generators of greater than 5 tons per calendar year.) <br /> 9. Mailing Address. 16300 Mckinley Ave <br /> I 1LHF0p CA 95330 <br /> city State Zip Code <br /> 10. Site Contact Person: Dilbagh Singh <br /> First Name Last Name <br /> Contact Person Address: 16300 Mckinley Ave <br /> Lathrop CA 95330 <br /> City State Zip Code <br /> Contact Person Phone Number: 2( 09 ) 5351800 Fax Number: 2t 09 ) 9234335 <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address:dgmaster.repair@gmail.com <br /> 11. Legal Business Owner(not property owner): Dllbagh Singh <br /> 16300 Mckinley Ave Name Lathrop CA 95330 <br /> Owner Address: y p <br /> s ('P 09 5351800 C`ty 209 s��34335 zip Code <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) <br /> 13. Certification: I certify under penalty of law that the information on this document was prepared to the best of my knowledge and <br /> belief to be true,accurate and complete. <br /> SIGNATURE(handwritten) Date 12(9/19 <br /> Name(print) Dllbagh Singh Title Owner Phone 2095351800 <br /> DTSC Form 1358(136119) <br /> Page 3 of 3 <br />