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Department of Toxic Substances Control <br /> State of California — California Environmental Protection Agency Office of Environmental Information Management <br /> PERMANENT STATE ID NUMBER APPLICATION <br /> Please type or print legibly in ink. <br /> rNEWqUMBER REQUESTS Check all that apply . <br /> pplying for a new permanent California ID number as a hazardous waste : ❑ Generator ❑ Transporter <br /> or a new number: A . ❑ Never had a number B . ❑ Business moved C . ❑ Legal owner of business :changedss generates greater than 100 kg of RCRA hazardous waste other than those hazardous waste listed in 405 <br /> e complete Form 8700- 12 for a federal EPA ID number. <br /> subparts (c) and (d) per month, pleas <br /> r2 , l <br /> D STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER <br /> D number : C A L 0 0 0 4 2 6 9 8 <br /> pdating the mailing address and/or contact information only . <br /> . activating this ID number. <br /> L1 4 . 1 am reactivating this ID number . Reason (please select one) : A . Verification Questionnaire Be Other <br /> ❑ <br /> ❑ 5 . 1 am changing the business name only , no ownership change . <br /> F <br /> acility/Business Name ( Include DBA) : East Bay Tire Co <br /> ocation : 2807 Hwy q9 West Frontage Road <br /> StoSt CA 95215 San Joaquin <br /> State Zip Code County <br /> City 94-2656190 b CDTFA Account Number <br /> 8 . (a) Federal Employer ID Number ((b) is only required from generators of greater than 5 tons per calendar year.) <br /> 9 . Mailing Address : 2200 HUntington Drive <br /> CA 94533 <br /> FsairTield ZipCode <br /> State <br /> Cit <br /> 10 . Site Contact Person : Javier GarciaFirst Name Last Name <br /> Contact Person Address : 2807 Hwy 99 West Frontage Road <br /> Street CA 95215 <br /> Stockton Zip Code <br /> City State <br /> 209 850-0701 Fax Number: L. <br /> Contact Person Phone Number: Area Code Fax Number <br /> Area Code Phone Number <br /> Contact Person Business Email Address : Jgarcia@eastbaytire . com <br /> FLegalusiness Owner (not property owner) : East Bay Tire Co <br /> Address : 2200 HUntington Drive Fairi<ie(d CA 94533 state zip code <br /> Stre City <br /> x/ 07 437 -4700 Fax Number: L� <br /> Owner Phone Number: LL Area Code Fax Number <br /> Area Code Phone Number <br /> 12 , Standard Industrial Classification (SIC) Code for the Site : 7 6 9 9 (4- Digit Number)_ — <br /> F13 . Certification : 1 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, accurat d complete DateGNATURE (handwritten 209 -471 -4079 <br /> Name (print) <br /> Jason Whi e Title Compliance Manager Phone <br /> DTSC Form 1358 (06/19 ) Page 3 of 3 <br />