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California Environmental Protection Agency <br /> Permanent State ID Number Application Department of Toxic Substances Control <br /> DTSC Form 1358 ( Revision 05/20 ) Page 1 of 2 <br /> NEW NUMBER REQUESTS . Check all that apply <br /> ❑ 1 . 1 am applying for a new permanent State ID number as a hazardous waste : <br /> ❑ a ) Generator ❑ b ) Transporter <br /> Reason for a new number : <br /> ❑ a ) Never had a number ❑ b ) Business moved ❑ c) Legal business owner changed <br /> If your business generates greater than 100 kg of RCRA hazardous waste other than those <br /> hazardous wastes listed in 40 CFR 261 . 5subparts ( c) and (d ) per month , complete the EPA <br /> Form 8700 - 12 for a federal EPA ID number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER <br /> For existing ID number ( include the lettered prefix) : L.O L 772 <br /> ❑ 2 . 1 am updating the mailing address and /or contact information only . <br /> ❑ 3 . 1 am inactivating this ID number . <br /> 4 . 1 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) : �p *e5 � �-�e '� S; c �-• , <br /> 7 . Site Location : I oo ; � 0« VNe <br /> Street <br /> J <br /> City State ZIP Code County <br /> r , - <br /> 8 . a) Federal Employer ID Number : _ <br /> _❑ <br /> b ) CDTFA Account Number : <br /> This is only required from generators of greater than 5 tons per caf ArLlo r . <br /> 9 . Mailing Address : ` � � �r � ® F- ' <br /> Street <br /> City State ZIP Code <br />