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.• HAZP.R000S WASTE TRANSPORTER REGISTRATION APPLICATION 1. NAME OF LEGAL ENTITY-Enter the name under which you are applying for the registration.Yov must complete both lines 1 and 3 even if they are the same. 2. TRANSPORTER REGISTRATION NUMBER- Por new application, leave blank. For renewal, Reinstatemenq or Midyear Amendment,enter your current Registration Number. 3. BUSINESS NAME- • Hnter the name,the"DBA"(doing business as)n or fictitious n me under which you ere doing business.This will be the same name that will appear on the Registration Cert:flcem issued by DTSC, the Certificate of Insurance for Public Liability Coverage<Porm DTSC 8038),and the Endorsement for Motor Carrier Policies of insurance for Public Liability(Form MCS- 90). • I{you have more then one DBA or fictitious name,you must apply for a separate registration for each pBA or fictitious name under which you will transport hazardous waste. • Then a (or logo) shown on the registration certificate MUST be dsplayed on all vehicles, end must be shown on the California Uniform Hazardous Waste Manifest. 4. APPLICATION TYPE-Check one box for appropriate application type. 5. BUSINESS ADDRESS-Enter the complete business address. 6. MAILING ADDRESS-Enter the complete mailing address. 7. CONTACT NUMBERS-Enter the telephone number,fez number and e-mail address of the business contact person. 8. TRANSPORTER IDENTH+ICAT[ON NUMBER (Also Known as EPA ID Number) - You mus[ have an idcnti{cation number to transport hazardous waste. Current identification n tubers c slat of throe lettere followed by nine digits. Previous/early federally-issued identification numbers consist of two letters followed by ten digits. • If you plan to transport non-AGAR hazardous waste and da no[have an idcnti{cation number,complete DTSC Form 1358 i and submit tc DTSC along with your application for ragiatration.DTSC will assign en identification number to you and place this number on your application. • IF you plan to transport RCRA hazardous warte, you must submit the EPA Form No. 8'JOO-l2 to tfie United States Environmental Protection Agency (U.S.EPA),Region IX, 135 Main Street, Suite 1800, San Prancisco, CA 94105.Indicate n the registration application that the identification number is pending, submit your application to DTSC end call to report the identification number when i[is issued. • For transporters with more then one identification number, list ell identification numbers that your business uses to transport hazardous west¢.If necessary,list additional identification numbers on a separate sheet. 9. OTHER BUSINESS ADDRESSES)- . If you have more than one business location,list ell the Following applicable locations: • Terminals,transfer facilities,or other locations From which you intend to operate under this regisn�afiw. • All locations at which you regularly perk any of your vehicles)or containers used io ttansporf hazardous waste. • All locations at which busimsa 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, licensee,permits,and rogistmtiona. 10. OWNERSHIP OF BUSINESS-Check ane box. • Sola proor'ators h'o and Partnarsh'p : list nama(s) and titles) of all members. If you have no California locations, include an agent for service of process (the person authorized to accept legal service). • Corooratian and Limited Liability Cmnoanv: Ist neme(s)and fltle(s) of officers, including agent{r service of process (the person authorized to accept legal service and whose name is shown on the Articles of Incorporation). • Other:Please describe. ]1. The business owner or officer who is authorized to make decisions£or the business shall sign in tfie space provided using blue or other non-black ink.Enter the full printed name and fide of the person signing the form,and the date that the{ren was signed. 0rsc tsv<vrov)