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WAUU/IUUU <br /> 05/22/2008 THU 8: 59 FAX 2 9468` 13 SJC EHD <br /> Department of Toxic Substances <br /> State of California—California Envi nmental Protection Agency <br /> Co -GISS <br /> P.O.Box <br /> 806 <br /> Sacramento.CA 95812-0806 <br /> Californi Hazardous Waste Permanent ID Number Application <br /> Please type r neatly print in ink. Please review the line-by-line instructions carefully. <br /> To check on he status of our re ues oto www.hwts.dtsc.ca. ov and click on R See instntctions.) <br /> New Number Requests. Check Il that apply. <br /> ❑ 1. I am applying for a new rmanent California ID number as a hazardous waste: ❑ Generator ❑Transporter <br /> nged <br /> C. <br /> Reason for nen Yumber:eQ o Never had a number B. ch n 100 kg of RCR4 hazardous per month usiness ,contact US EP for a'federal ID l owner of business number. <br /> If your business generates g+' <br /> Chan es to Status or Informat n for an Existin ID Number. <br /> (See instructions.) <br /> For existing ID number: C A -�- <br /> ❑ 2. I am updating the mailing Lddress and/or contact information only. <br /> ❑ 3. 1 am inactivating this ID N umber. <br /> . I am reactivating this ID Ts umber. <br /> ❑ 5. I am changing the busines name. There has been no ownership change. <br /> (See instructions.) <br /> 6. Site/Facility/Business Name Include DBA): <br /> 7. Site Location: % W <br /> rber77 <br /> State Zip County <br /> c� <br /> 8.(a)Federal Employer �°(b)Board of Equalization Fee Account Number: <br /> )is only required from generators o f greater than 5 tons per calendar year.) <br /> (See instructions.) <br /> 9. Mailing Address: L l�`` <br /> ityState ip <br /> (See instnwtions.) <br /> 10. Site Contact Person: ZLYLast Name <br /> irst Name <br /> Contact Person Address: W <br /> Street <br /> rX&L- <br /> ity State Zip <br /> V <br /> Contact Person Phone Num er: ( ) 53 ZCYL) Fax Number: 45135- <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business E nail Address: ►��5��'^�1 5�� <br /> Preferred Primary Commu ication: ❑ Mail Email <br /> (See instructions) <br /> 11. Legal Business O4Ar <br /> erty owner) <br /> Name S � <br /> Owner Address: City State Zi� <br /> U 3 0_XUL� Fax Number: (etL�i) — <br /> Owner Phone NArea Code Fax Number <br /> e Phone Number <br /> 1tandard Industrial Classi cation(SIC)Code for the Site: Z �Q g (4-Digit Number) (See instructions.) <br /> DLStandard <br /> www.dtsc.ca.gov <br /> DTSC Form 1358(5/07) <br />