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State of California — California Protection Agency Department of Toxic Substances Control - GISS P.O. Box 806 Sacramento, CA 95812-0806 CaliforniaHazardous Waste Permanent ID Number Application Please typi or neatly print in ink. Please review the line -by-line instructions carefully. To check on the status of our request, o to www.hwts.dtsc.caov and click on Reports. New Number Reauests. Chech all that apply. (See instructions) ❑ 1. 1 am applying for a new r ermanent California ID number as a hazardous waste: ❑ Generator ❑ Transporter Reason for new number:13Never had a number B. ❑ Business moved C. C3Legal owner of business changed If vour business generates great r than 100 ke ofRCRA hazardous waste per month, contact US EPA for a federal ID number. For existing ID number: C A ❑ 2. I am updating the mailing address and/or contact information only. ❑ 3. I am inactivating this ID Number. ❑ 4. I am reactivating this ID Number. ❑ 5. I am changing the busines name. There has been no ownership c1 6. Site/Facility/Business Name 7. Site Location: 8. (a) Federal Employer ID Num 9. Mailing Address: DBA): (See instructions.) (See instructions.) State Zip County _ (b) Board of Equalization Fee Account Number:_ is only required from generators ofgreater than S tons State calendar year.) (See instructions.) 10. Site Contact Person: F Contact Person Address: Street C Contact Person Phone Numb Contact Person Business Emit Preferred Primary Communloperty (See instructions.) rst Name Last Name ity State Zip r: (_� Fax Number: (� Area Code Phone Number Area Code Fax Number Address: ation: ❑ Mail El Email 11. Legal Business Owner (not Owner Address: (See instructions.) owner): Name Street Owner Phone Number: ( Area City State Zip Fax Number: ode Phone Number Area Code Fax Number 12. Standard Industrial Classific tion (SIC) Code for the Site: (4 -Digit Number) (See instructions.) DTSC Form 1358 (7/06) 1 www.dtsc.ca.gov