Laserfiche WebLink
afar -17 2004 11:00am From-RYDER S, /ENTG {9'. 3i2 Z?0, i 620 P 002/CO2 F-698 <br />R0, Box 806 <br />S&=amctzto, CA 95813-0806 <br />California Hazardous Waste Permanent ID Numb-er Application <br />,Please reLiew the litre-b}',ltne instructions carefully and complete all irems on the application. <br />New NuMber%quests. Cbcck all that Apply_ (See instruchinns) <br />I am 8ppiying for anew parr:ka=rtt CaIifozuia ID number as a: [ I Generator [ I Transporter <br />Reason for =w ntunbcr. A ( ) Never had a nu nber B. [ ] Business moycd C. [ 3 Legal owner of business cbxnged <br />1 Chimes to Status or tnformafion _ (See instructions.) <br />For ID number: CA L <br />L ] Z. I am updating the tn•t31in.- address and/or contact infomation only. <br />[ ] 3. 1 am inactivating chis ID Number - <br />4. I am reactivating ibis ID Number. <br />J] 5. 1 am changng the, business name. There Itis been no ownership change. <br />6. This site is a: [ ] Ca4tionally Exempt Small Quardty Generator of RCRA Waste (See instructions.) <br />a Generator of less than 1,900 kg(mont:h California -only waste <br />C I Generator of greater than 1,000 kg/momh California -only waste <br />7. Site/Fad-lity Na=. <br />8. Site Location: 12 (_ I3, � 'Qld ,! h - k P e- /.- j 11 e— <br />Street <br />City state zip County <br />(See insrrucrions.) <br />9_ Halling Address. e� CD ��19_ _ _Gc�k -- -��� �Ri ��.% <br />stet <br />City State Zip <br />10. Site Contact Person: <br />(See instructions-) <br />First Name Last Name <br />Con= Person Address: _ 3 Lam— - __I 4, e �2 < fy CL <br />STate Zip <br />Cob:Tact Person Phone Namber: (jO-S Fax Number: QCI <br />Azca Code Phone N►smber Area Code Fax Number <br />Comet Person Busilless Email Address: <br />PrderredPrimary Communication 1&il <br />�j ) (Ste instructions) <br />11. Legal Business Owner (not property owner): w CSF _ ,t �M _Z C'6 <br />Name/ <br />� <br />Owner Address:otm <br />nG <br />Street City Stite Z p� <br />Owner i'hanc Number (,� <br />Area Codc Phone Number w <br />12. Standard Industrial Classification (SIC) Cod: for the Site: 7 ,5 / � (4 -Digit Number) (See itrstruclions j <br />DTSC 1359 10/03 <br />6 'd 6VZ6'ON 8tiH -0 6-6N 'dSNVK d10A D61:11 VCH '81'JEN <br />