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HAZARDOUS WASTE TRANSPORTER REGISTRATION APPLICATION 1. NAME OF LEGAL ENTITY-Enter the name under which you are applying for the registration. You must complete botV. lines 1 and 3 even if they are the same. 2. TRANSPORTER REGISTRATION NUMBER- For nein application, leave blank. For renewal. Reinstatement. or Midyear Amendment,enter your current Registration Number. 3. BUSINESS NAME- * Enter the name,the"DBA"(doing business as natr_e,or fictitious name under which you are doing business.This will be the sarre came that will appear on the Registration Certificate issued by DISC, the Certificate of Insurance for Public Liabilit'. Coverage(Form DTSC 8038),and the Endorsement for Motor Carrier Poiicies of Insurance for Public Liability (Form MCS_ 90). • if you crave more than one DBA or fictitious name,you must apply for a separate registration for each DBA or fictitious name under whicF you will transport hazardous waste. • The name (or logo) shown on the registration certificate MUST be displayed on all vehicles, and must be shown on the Caiiforma Uniform Hazardous Waste Manifest. 4. APPLICATION TYPE-Check one box for appropriate application type. 3. BUSINESS ADDRESS-Enter the complete business address. 6. M AILING ADDRESS-Enter the complete mailing address. 7. CONTACT NUMBERS-Enter the telephone number,fax number and e-mail address of the business contact person. 8. TRANSPORTER IDENTIFICATION NUMBER (Also Known as EPA ID ?cumber) - You must have an identification number to transport hazardous waste. Current identification numbers consist of three letters followed by nine digits, Previott_siearly federally-issued identification numbers consist of two letters followed by ten digits. • If you plan to transport non-RCRA hazardous waste and do not have an identification number,complete DISC Form 1358 and submit to DTSC along with your application for registration,DTSC will assign an identification number to you and place this number on your application. • If you plan to transport RCRA hazardous waste, you must submit the EPA Form No. 8700-12 to the United Slates Environmental Protection Agency(U.S. EPA), Region IX, 135 Main Street, Suite 1800,San Francisco,C3 94105. Indicate on the registration application that the identification number is pending,submit your application to DTSC and call to repor. the identification number when it is issued. • For transporters with more than one identification number, list all identification numbers that your business uses to transpor. hazanlo-as waste. If necessary,list additional identification numbers on a separate sheet. 9. OTHER BUSINESS ADDRESS(ES)- • if you have more than one business location,list all the fallowing applicable locations: • Terminals,transfer facilities,or other locations from which you intend to operate under this registration. • All locations at which you regularly park any of your vehicle(s)or containers used to transport hazardous waste. • All locations at which business and operating records relating to your hazardous waste activities can be found. These records should include, but are not limited to, manifests and other shipping papers, driver's logs, vehicle maintenance records. licenses,permits,and registrations. 10. OWNERSHIP OF BUSINESS-Check one box. • Sole proprietorship and Partnership,: list name(s)and title(s) of all members. If you have no California locations, include an agent for service of process(the persor+authorizad to accept legal service ). • Co oration and Limited Liability Company: list name(s) and tide(s)of officers, including agent for service of process (the person authorized to accept legal service and whose name is shown on the Articles of Incorporation). • Other: Please describe. 11. The business owner or officer who is authorized to make decisions for the business shall sign in the space provided us--ng blue or other non-black ink.Enter the foil printed name and title of the person signing the form,and the date that the form was signed. DTSC 187(T-IN)