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i State of California—Califomia Environmental Protection Agency Department of Toxic Substances Control-GISS P.O.Box 806,Sacramento,CA 95812-0806 OR CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or neatly print in ink. Please review the line-by-line instructions carefully. To check on the status of your request,go to 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: P 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 EPA for a federal ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) For existing ID number: C A l- -P-- LL o ,, d, y ❑ 2. 1 am updating the mailing address and/or contact information only. ❑ 3. 1 am inactivating this ID Number. ® 4. 1 am reactivating this ID Number. 5. 1 am changing the business name only,no ownership (See Instr c(ions.) 6. SiteiFacility/Business Name(Include DBA): I701/�?ILAiil�jTtly7 7K � IL7�l d} �U1L�I �A((Lh— . l?Y'Ylill cr J e/ t� 7. Site Location: �VW � il(kUMA) � ✓�l�r �ItCr, tCi? meet ysao -3319 4t �a�cW tU l City O State Zip County 8.(a)Federal Employer ID Number 9�f IGDb��(�b (b)Board of Equalization Fee Account Number _ ((b)is only required from generators of greater than 5 tons per calendar ear.) r (See instructions.) 9. Halling Address: � 441 StreetC�L i 3�2 l %SaD/ City State Zip �'n1 i �_• (See instructions.) 10. Site Contact Person: �a'1I d� �{r�t� First Name Q c Last Name Contact Person Address: _ '� I✓ �Q�LP 4� 7� - SAe v4 V , gSaOlo City Stale Zip Contact Person Phone Number. ( � (a�� 7�3 Fax Number: 4i� —517( Area Code (�Phone Number Area Code Fax Number Contact Person Business Email Address: YI C1Y/?' V)1lCS Preferred Primary Communication:rl Mail 17IS-mail See instructions.) 11. Legal Business Owner(not properly owner): 1� Owner Address: 26ylkPie s�d3 Street City State Zfo Owner Phone Number. v�d X00-' S 4 Fax Number: ( 4{00 SlL3 Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: 3 (4-Digit Number) (Sea instructions.) 13. Certification: I cei u der enmity of w that the information on this document was prepared to the best of my knowledge and belief to be,true, ccur to a �comp0te. SIGNATURE' r� /t DATE �r NAME(print) "D(, TITLE ! �i PHONE �m `�b' 3 �i><ta�6Y1 DTSC Form 1358(6/08)