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State of California—California Environmental Protection Agency Department of Toxic Substances Control-GISS .. P.O.Box 806,Sacramento,CA 95812-0806 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 nur request,go to wwwbMd%dtsc.2gqgy and dick on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) 1. i am applying for a new permanent California ID number as a hazardous waste: F✓ Generator ®Transporter Reason for new number: A. ® Never had a number B. ® Business movedC_ E)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 10 number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions_) For existing ID number: CA L 0 0 0 2 9 8 7 5 1 ® 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. [J 5. 1 am changing the business name only,no ownership change. (Sea instructions.) 6. Site/Facility/Business Name(include DBA): F&H Construction 7. Site Location: 4945 East Waterloo Road Street CA 95215 San Joaquin Stockton City State Zip County 8.(a)Federal Employer ID Number 94-2165460 Board of Equalization Fee Account Number ((b)is only required from generators of greater than 5 tons per calendar year.) (See instructions.) 9. Mailing Address: P.O. Box 55245 Street C Stockton A 952105 City State Zip Murphy (See instructions.) 10. Site Contact Person: Jane First Name Last Name Contact Person Address: 4945 East Waterloo Road Street C Stockton A 95216 City State Zip Contact Person Phone Number: 2( p9 ) 931-3738 Fax Number: 2( 09 ? 931-4427 Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: Imurphy@f-hconst.com Preferred Primary Communication:[]✓ Mail [Z]Email (See instructions.) 11. Legal Business Owner(not property owner): Harold Jones, President Name Owner Address: 4945 East Waterloo Road Stockton CA 95215 Street City State Zip Owner Phone Number ( 09 ) 931-3738 Fax Number: (_209 ) 931-4427 Area Code Phone Number Area Code Fax Number 12. Standard industrial Classification(SIC)Code for the Site: 1 5 3 1 (4-Digit Number) (See instructions.) 13. Certification: l certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to be, tr ,accurate and complete. SIGNATURE DATE h" ® NAME(print)-- ne Mur h TiTLEOffiCe Manager _ PHONE (209} 931-3' 38 DTSC Form 1358(8108)