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State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> Office of Environmental Information Management <br /> PERMANENT STATE ID NUMBER APPLICATION <br /> Please type or print legibly in Ink. <br /> NEW NUMBER REQUESTS Check all that apply. <br /> it 1. 1 am applying for a new permanent California ID number as a hazardous waste: IV Generator ❑Transporter <br /> Reason for a new number: A. IF Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed <br /> If your business generates greater than 100 kg of RCRA hazardous waste other than those hazardous waste listed in 40 CFR 261.5 <br /> subparts(c)and(d)per month,please complete Form 8700-12 for a federal EPA 1D number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER <br /> For existing ID number: C A <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. Reason(please select one): A. ❑ Verification Questionnaire B. ❑ Other <br /> ❑ 5. 1 am changing the business name only,no ownership change. <br /> 6. Site/Facility/Business Name(Include DBA): Constellation Brands dba Turner Road Vintners West <br /> 7, Site Location: 5852 W Turner Rd, <br /> Lod1reel CA 95242 San Joaquin <br /> citystate ZJp Code unty <br /> 15_152887 <br /> 8.(a)Federal Employer ID Number (b)CDTFA Account Number N/�o <br /> ((b)is only required from generators of qreater than 5 tons per calendar year.) <br /> s. Mailing Address: 4614 West Turner Road <br /> L ` CA 95242 <br /> City state Do Code <br /> 10. Site Contact Person: Tony Sanfillipo <br /> First Name Last Name <br /> Contact Person Address: 5950 East Woodbridge Road <br /> Acampo CA 95220 <br /> City state Zip Code <br /> Contact Person Phone Number: 5( , 232'5399 Fax Number: <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address:tony.sanfillipo@cbrands.com <br /> 11. Legal Business Owner(not property owner): Constellation Brands Inc. <br /> Owner Address: 207 Highpoint Drive, Bldg 100, Victor NY 14564 <br /> stre@l85 city slate Zip code <br /> � <br /> Owner Phone Number: ) 678-7100 Fax Number: ( <br /> Area Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: 2 0 8 4 (4-Digit Number) <br /> 13. Certification:I certify under penalty of law that the information on this document was prepared to the best of my knowledge and <br /> belief to be true,accurate and co <br /> SIGNATURE(handwritten) Date Z <br /> Name(print) Tony Sanfillipo rtle General Manager Phone 559-232-5339 <br /> DTSC Form 1358(06119) <br /> Page 3 of 3 <br />