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State of Calitomia- Calif¢mia Environmental Protection Age icy Department of Toxic Substances Control - GISS P.D. Box 606, Sacramento, CA 958:2-0606 CALI ORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or ratty print in ink. Please review the ine-by-line instructions carefully. To check on the slatus of our request, o to vrww.hwts.dtsc.ca. ov and dick on Reports. NEW NUMBER REp STS Check at: that apply_ (See instructions.) f1. I am applying for anew permanent California ID number as a hazardous waste: Generator Transpor er Reason for new number: A. tcY Never had a number B. ❑ Business moved C. [] Legal owner of business changed if your business generates greaferlhan 100 kg of RCRA hazardous waste per month, contact US EPA for a federal iD number. (See instructions) For existing ID number: C A ❑ 2. 1 am updating the mailing address and/or contact information only. E] 3. t am inactivating this 10 Number [] 4. 1 am reactivating this ID Number. C] 5. 1 am changing the business name only, no ownership charge. ( instructions.) 6. Site/Facility/Business Name (induce DBA): 6 r+S cr c, F1t0ltirPG% 7. Site Location: / %0 l crrl Street_. � City r7 Y State Zip County 0 8_ (a) Federal Employer ID Number Board of Equalization Fee Account Number ((b) is only required from generators of greater than 5 tons per calendar year.) 9. Mailing Address: 170/ —&AL i:°c. C / / fW e (See ins&uctions.) 4 Street �� C4C4gr376/ cy City —7 State Zip . �/f / (See instructions.) 10. Site Contact Person: / W r Mr, /� /4f /j/, First Name Last Naryfe Contact Person Address: l / 0/ �,. IL-• LPG sz �uP street City State Zip Contact Person Phone Number. CLO?) g 3O -, ?32S— Fax Number. (?J5) P30 -33 26 Area Code Phone/Number Area Code Fax Number Contact Person Business Email Address: W S( SO rIC Preferred Primary Communication: Mail ❑ Emait h + G SrLhea / �i S 7>'� Jl (See instructions.) 11. Legal Business Owner (not property owner): /r'a c � Owner Address: Q GoW e77 '4yP i �4Cy C4 S-3 76 Street City State Zip Owner Phone Number. (ZA5 ) 8.30 - 3 Z o 0 Fax Number (i� Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classificaton (SIC) Code for the Site: 8 ' (4-1 Number) (See instructions.) 13. Certification: Icertify underpenaltyofJaw /that the belief to be, true, accurate and ggrnplete;