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State of California-California Environmental Protection Agency Department of Toxic Substances Control-GISS P.O.Box 806,Sacramento,CA 95812-0806 CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or neatly print in Ink. Please review the line-by-line instructions carefully. To check on the status of your request,go to and click on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) ❑ 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑Transporter Reason for new number: A. ❑ Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed If your business generates greater than 100 kg of RCRA hazardous waste per month, call(415)495-8895 for a federal ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See Instructions.) For existing ID number: C A L 0 0 0 3 7 9 0 8 5 ❑ 2. 1 am updating the mailing address and/or contact information only. ❑ 3. 1 am inactivating this ID Number. 8 4. 1 am reactivating this ID Number. ❑ 5. 1 am changing the business name only, no ownership change. (See instructions.) 6. Site/Facility/Business Name(Include DBA): City of Lathrop Corporation Yard/LAWTF 7. Site Location: 2112 E LOUISE AVE Street LATHROP CA 95330 SAN JOAQUIN CityState Zip County 8. (a)Federal Employer ID Number/0$'019 67196 1Sb (b) Board of Equalization Fee Account Number k0&425_,3 ((b)is only required from generators of greater than 5 tons per calendar year.) (See instructions.) 9. Mailing Address: 2112 LOUISE AVE Street LATHROP CA 95330 City State Zip (See instructions.) 10. Site Contact Person: MILTON DALEY First Name Last Name Contact Person Address: 2112 LOUISE AVE Street LATHROP CA 95330 City State Zip Contact Person Phone Number. 2( 09 ) 941-7475 Fax Number. 2( 09 ) 941-7449 Area Code Phone Number Area Code Fax Number Contact Person Business Email Address:mdaleyaci.lathrop.ca.us Preferred Primary Communication: d Mail ❑ Email (See instructions.) 11. Legal Business Owner(not property owner): CITY OF LATHROP Name Owner Address: 390 TOWNE CENTRE DR Street City State Zip Owner Phone Number: 2( 09 ) 941-7200 Fax Number: 2( 09 ) 941-7449 Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: 9 99 9 (4-Digit Number) (See instructions.) 13. Certificati I certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief t be, accurate and conplats— SIGNATURE o DATE 6-4-14 NAME(print) Dameon Flores TITLE Junior Enqineeer PHONE 209-941-7455 DTSC Form 1358(10112)