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State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> P.O.Box 806 <br /> Sacramento,CA 95812-0806 <br /> California Hazardous Waste Permanent ID Number Application <br /> Please review the instructions carefully and complete all items on the application. <br /> 1. Application for a permanent California ID number as a: ❑ Generator ❑ Transporter ❑ Both <br /> 2. This site is a: ❑ Large Quantity Generator ❑ Small Quantity Generator <br /> 3. Change in previously isE ued ID number: <br /> ❑ Inactivate ❑ Reactivate ID Number: <br /> 4. Site/Facility Name: <br /> 5. Site Location: <br /> S treet <br /> ity State Zip County <br /> 6. Mailing Address: <br /> S xeet <br /> ty State Zip <br /> 7. Site Contact Pers n: <br /> F rst Name Last Name <br /> Contact Person Address: <br /> Street <br /> City State Zip <br /> Contact Person PI ione Nu ber: U Fax Number: <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person usiness mail Address: <br /> Preferred Prim Comm nication: ❑ Mail ❑ Email <br /> 8. Legal Owner: <br /> Name <br /> Owner Address: <br /> Street City State Zip <br /> Owner Phone Number: <br /> ea Code Phone Number <br /> 9. Standard Industrial Classification(SIC)Code for the Site: (4-Digit Number) <br /> DTSC 13f 8 04/02/ 003 <br />