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Sep. 9. 2010 4: 31PM EMBASSY SUITES � �� No, 5882 P. 2 e—Gv\c- Stale of California-Callfomle Environmental rrolectlon Agency Repartmenl of Toxic Substances Control-OISS P.O.Box 806,Sacramento,CA 95812-0806 CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or neatly print In Ink. Please review the line-by-llm Instrudlons carefully. To check on the status of your request,go to www.hwls.dlsc.ca. ov and dick on Reports, NEW NUMBER REQUESTS Check all that apply. (See instructions.) ❑ 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑Transporter Reason for new number: A. ❑ Never 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 FICA for a federal ID number. CHANGES TO STATUS OR INFORMATION FOR AN L-41STING ID NUMBER (See Instructions) For existing ID number: C A -a P_ Q [� -a -io- _�_ 2. 1 am updating the mailing address and/or contact informallon only. ❑ 3. 1 am inacUvating this ID Number. 4. 1 am reactivating this ID Number. 5. 1 am changing the business name only, no ownership change. (See Instructions.) 6. Sita/Facility/Business Name(Include DhA): _ lJ r A \_n C l 7. Site Location: a.5 ?Z92 (A . _R ti Ain r\ R Stfeet .QQG�/ Clly Slate Zip Caunly 8. (a)Federal Employer ID Number (b)Board of Equalization Fee Aocount Number ((b)Is only required from generators of greater than 5 tons per calendar year.) A. Mailing Address: c,J ^� l (See instructions.) - � �� Street :1 PAq city 't State Zip 10, Site Contact Person: y12 C R Ver (See instruc(/ons.) First Name `�;� Last Name Contact Person Address: I5 •)—d L Y Zo,_ Street T e, 553 7) City T Stale Zip Contact Person Phone Number. cLOJ—) 713 -77 Fax Number. � ) Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: Preferred Primary Communication: Mail ❑Email T AA p (See Instructions.) 4 11, Legal Business Owner(not property owner): T + C "a Nama Owner Address: 5?3 -mkD,__Zc✓u-- 13(L-/�_ Wigtks !A, 5 03 5 Streat City Stale 2Ip Owner Phone Number. ( vol) 26 L— S iG Fax Number. (Y�) 2f.z -zz o Area Code Phone Number Area Coda Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: 5 (4-Digit Number) (See instructions.) 13. Certilcallon, l certify under penally of law that the Information on this document was prepared to the best of my knowledge and belief to be, true, accurate and complete ee SIGNATURE L^r�/� DATE NAME(print)-77f 2 h / TITLE C R PHONE DTSC Form 1358(6/08)