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Zenith Machining Inc Record ID# PR0538497 <br /> May 29, 2019 Program: HW <br /> 124 N E St, Stockton, CA 95205 <br /> PHOTO 3: DTSC form 1358 filled out and emailed to the DTSC while inspector was on site to apply for a State ID number. <br /> stare of�<lrf�,ne_�,l„o n a�naronr,. <br /> �mrAa� <br /> NEw NUMBS pEHMANENT STATE ID NUMBER APPLICATION <br /> RE U -TS Cneck aii Ih.ri.nyriy 1 _______ <br /> am-­10.” 'yVd.�i Irnnl l.,yiply In inti __ <br /> Rea n for for anew permanent Calilpniia ID number as a hazardous wasto <br /> frYnur br ac-i es anew number: A. I Never heti a n w Gena.awr tl Tnnaporter <br /> .ttfbparfs f�'1 an✓gd rotates groats.roan!pd A umbar B IJ Business moved G 1.1 Legal ao,, �angeq <br /> I I Por roonf/f,Pleasm4/e n FUCn_>00-a�ouv waste other Ihan fhosu hararCoua waste Lsh�.J rrr ip rt:R J6r 5 <br /> _ 12/ora/uryenl EPA ID nurnhnr <br /> CHANGES TO STATUS OR INFORMATION FOR AN E%ISTING STATE ID NUMBER <br /> For erisling ID number_ (�`A <br /> CI 2. <br /> "m updating the in"'ng ————————— <br /> 0 3. I am Inactivaf g address anNor contact Information only <br /> 'ng this ID number <br /> 11 4. "m reactivating this ID number, Reason(please select one): A. ❑ Ve'r—tion Questionnaire <br /> O 5. 1 am changing Ne business name onl ipchange. <br /> B. Other <br /> y.no ownershf� <br /> 6. Ste/Facilityfeusiness Name(Include DBA): ZEN—TN MAC/I/I�i/✓6 <br /> 7. Site Location:/,/f F- <br /> STotc. G/7 YS�oS CAN TAB �f <br /> Cty msAca eoenry <br /> 8-(a)Federal Employer ID Nuber P/-R9Y59 a4 (b)tate lon Board of Equalization F Account Number <br /> 1 ((b)is only required from generators or greater than S Ions per calendar year.) <br /> 9. Mailing Address: /�qt Y <br /> cn state Zi code <br /> 10. Site Contact Person: AVT T}x/d ,-1 Al <br /> First Name Last Name <br /> Contact Person Address: E <br /> Street X <br /> City State Zip Code <br /> Contact Person Phone Number: 9( /6) 595 neo Fax Number:(� <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address: DZ ZeAgAll <br /> (�ST/I <br /> 11. Legal Business Owner(not property owner): 4,p--% Y,mo/J N <br /> 1I11 Name <br /> Owner Address: <br /> Street City State Zip Code <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. Certification:/certify underpenalty of law that the information on this document was prepared to the best of my knowledge and <br /> befief to be true,accurate and complete. <br /> C <br /> SIGNATURE(handwritten) /// Date S 199 <br /> fY <br /> Name(print) &77�Y A 40,�fR/� Title G 1Y7Phone A'97-q y 1 A y I/ <br /> OTSC Form 1358(09/18) <br /> Page 3 of 3 <br /> Tricia Dai, EHS Page 3 of 3 <br />