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CONSOLIDATED TRANSPORTER NOTIFICATION <br /> 1. BUSINESS NAME- <br /> . Enter the name,the"DBA"(doing business as)name,or Fictitious name under which you are doing business.This will be the <br /> same name that will appear on the Registration Certificate issued by DTSC,the Certificate of Insurance for Public Liability <br /> Coverage(Form DTSC 8038),and the Endorsement for Motor Carrier Policies of Insurance for Public Liability(Form MCS- <br /> 90). <br /> If you have more than one DBA or fictitious name, you must apply for a separate registration for each DBA or fictitious <br /> name ander which you will transport hazardous waste. <br /> 2. TRANSPORTER REGISTRATION NUMBER-Enter your current Registration Number. <br /> 3. BUSINESS ADDRESS-Enter the complete business address. <br /> 4. MAILING ADDRESS-Enter the complete mailing address. <br /> 5. CONTACT NUMBERS-Enter the telephone number,fax number and e-mail address of the business contact person. <br /> 6. IDENTIFICATION NUMBER(Also Known as EPA 1D Number)- <br /> If your company transports hazardous wastes,operates the designated facility,and intends to submit only the facility copy of the <br /> consolidated manifests pursuant to Health and Safety Code Section 25160(b)(5)(A), you must provide all the transporter and <br /> facility identification numbers used by your oompany on these manifests. <br /> 7. Check all applicable boxes of wastestrearns that you plan to transport under the consolidated manifesting procedure, as described <br /> in Flealth and Safety Code,Section 25160.2. <br /> 8. The business owner or officer who is authorized to make decis-.ons for the business shall sign in the space provided. <br /> Enter the fall printed name and title of the person signing the Form and the date that the form was signed. Since the origins: <br /> signature is required on the form,please use blue or other non-black ink. <br /> DTSC 1299 I?/091 <br />