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Received by the SJCEHD (JA) on 7/27/2020 <br /> 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): <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 /> — <br /> 6. Site/Facility/Business Name (include DBA): � <br /> 7. Site Location: b <br /> Street <br /> -j <br /> ! -'Tvk_ -Zo1�- <br /> City State ZIP Code County <br /> 8. a) Federal Employer ID Number: D�� Y'�' (,/,-e 710 <br /> b) CDTFA Account Number: <br /> This is only required from generators of greater than 5 tons per calendar year. <br /> 9. Mailing Address: Z3o� ❑� ° ''/���� !.c%y <br /> Street <br /> City State ZIP Code <br />