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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 rint le ibl in ink. <br /> NEW NUMBER REQUESTS Check all that apply. <br /> W1 1. 1 am applying for a new permanent California ID number as a hazardous waste: W Generator ❑ Transporter <br /> Reason for a new number: A. 10 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 ID 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): CRM CO. LLC <br /> 7. Site Location: 1404 S. Fresno Ave <br /> Stof �n CA 95206 San Joaquin <br /> City State Zip Code County <br /> 33-0789200 <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: 1404 S. Fresno Ave <br /> S168kton CA 95206 <br /> City State Zip Code <br /> 10. Site Contact Person: Stephen Krauss <br /> First Name Last Name <br /> Contact Person Address: 1404 S. Fresno Ave <br /> StocKlon CA 95206 <br /> City State Zip Code <br /> Contact Person Phone Number: (916 ) 584-5158 Fax Number: (� <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address:skrauss@crmrubber.com <br /> 11. Legal Business Owner(not property owner): <br /> CRM CO., LLC <br /> Owner Address: 1301 Dove Street Suitellffir6 Newport Beach CA 92660 <br /> s '549 263-9100 city 949 SM3-9110 zip code <br /> Owner Phone Number:: (�) Fax Number: ( ) <br /> Area Code Phone Number Area Code Fax Number <br /> F12. Standard Industrial Classification(SIC)Code for the Site: 5 0 9 3 (4-Digit Number) <br /> 13. Certification: /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 an4cletp. <br /> SIGNATURE(handwritten} Date <br /> Title Regional Manager Phone 209-662-6090 <br /> Name(print) Stephen Krau <br /> DTSC Form 1358(06/19) <br /> Page 3 of 3 <br />