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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 /> ❑ 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑ Transporter <br /> Reason for a new number: A. ❑ 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 FPA ID number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER <br /> For existing ID number: C A L 0 0 0 4 2 8 2 9 4 <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 /> 0. Site/Facility/Business Name (include DBA): HECTOR A REYNOSO SANCHEZ DBA HECTOR REYNOSO M( <br /> 7. Site Location: 1 055 S STOCKTON ST <br /> ST(5UkTO N CA 95206 SAN JOAQ U I N <br /> City 37-1826330 State Zip Code County <br /> 8. (a) Federal Employer ID Number (b) CDTFA Account Number <br /> ((b) is only required from generators of greater than 5 tons per calendar year.) <br /> 9. Mailing Address: 1 055 S STOCKTON ST <br /> StCKTON CA 95206 <br /> city State Zip Code <br /> 10. Site Contact Person: HECTOR REYNOSO <br /> First Name Last Name <br /> Contact Person Address: 1055 S STOCKTON ST <br /> S1SockTON CA 95206 <br /> City State Zip Code <br /> Contact Person Phone Number: 2{09) 2626636 Fax Numb6r: �} <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address:hectorreynoso58@yahoo.com <br /> 11. Legal Business Owner (not property owner): HECTOR REYNOSO <br /> Owner Address: 1055 S STOCKTON STNMCKTON CA 95206 <br /> Stre109 2626636 city State zip Cade <br /> Owner Phone Number: ( Fax Number: ( _) <br /> Area Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Classification (SIC) Code for the Site: (4-Digit Number) <br /> 13. Cerfification: I certify under penalty of law that tip information cement was prepared to the best of my knowledge and <br /> belief to be true, accurate and comp t . <br /> SIGNATURE (handwritten) Date <br /> 4123/zo2o <br /> Name (print) HECTOR REYN Title OWNER Phone 2092626636 <br /> DTSC Form 9358 (06119) <br /> Page 3 of 3 <br />