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09/27/2011 16:51 209-233-1002 TRACY POWER EQUIP PAGE 01101 <br />State of California - California Environmental Protection Agency Department of Toxfc Substances Control - GISS <br />P.O. Box W6, Sacramento, CA 95612-0606 <br />CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br />Please type or neatly print in Ink. Please review the Ilne-by-tine instructions carefully. <br />To check on the status of your request, go to www,hwts.dtsc.cagpy and click on Reports. <br />NEW NUMBER REQUESTS Check all that apply, (See instructions.) <br />1. 1 am applying for a new permanent California ID number as a hazardous waste: [] Generator Transporter <br />Reason for new number, A. [] Never had a number B, F1 Business moved C. F1 Legal owner of business changed <br />If your business generates greater than 100 1t of RCRA hazardous waste per month, contact LfS EPA fors federal ID number. <br />CHANGES TO STATQSO INFORMATION FOR AN EXISTING ID UlJMBFLR <br />For existing ID number, C A i.— � -Q- _ 0 I <br />❑ 2. 1 am updating the mailing address and/or contact information only, <br />[] 3. 1 am inactivating this ID Number. <br />4. f am reactivating this ID Number. <br />5. 1 am changing the business name only, no ownership change. <br />6. Site/Facility/Business Name (Include DBA): <br />7, Site Location: <br />City L <br />8. (a) Federal Employer ID Number, <br />(See instructions.) <br />SEF 2 8 2Uti <br />:SA1V �CAGrCt� <br />tate Zip County <br />Board of Equalization Fee Account Number <br />is only required from generators of gr>sater than 5 tons <br />9. Mailing Address: (See instructions_) <br />Street <br />City State Zip <br />10. Site Contact Person: <br />Contact Person Address <br />(See instructions.) <br />Last Name <br />Contact Person Phone Number: (�) 6 3 — ( 0 00 Fax Number: ( ) . 3� — aZ. <br />AAraaa Code Phone Number Area Code Fax Number <br />Contact Person Business !:mail Ad rd asst ,(py 9 —&Lo ij N—. WE <br />Preferred Primary Comm unIca tion! ]Mail �-Emai <br />11. Legal Business Owner (not property owner): <br />Name <br />Owner Address: aLL-es , r�w� <br />Street <br />Owner Phone Number: (707) 2-Sa, gyp, <br />Area Code Phone Number <br />12. Standard Industrial Classification (SIC) Code for the Site <br />_ AH �' l__l " <br />. <br />city State <br />Fax Number. (20) -Z—CAS-- <br />Area Code Fa <br />Numb <br />(See instructions.) <br />13. Certification: I cer7,fy under penalty of law that tho information on this document was prepared to the best of my knowledge and <br />belief to e, , accurate an complete. r r <br />SIGNATURE DATE <br />NAME (print) _ TITL � 1,J�b-{`_ PHONEA-9 <br />DISC Form 1358 <br />