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State of California—Cali fornia Environmental Protection Agency Department of Toxic Substances Control-GISS <br /> P.O.Box 806 <br /> Sacramento,CA 95812-0806 <br /> C liforn a Hazardous Waste Permanent ID Number Application <br /> lease typ or neatly print in ink. Please review the line-bv-line instructions carefully. <br /> To check ol the status of your request,go to www.hwts.dtsc.ca.aov and click on Reports. <br /> New Number Requests. Chec all that apply. (See instructions.) <br /> ❑ 1. I am applying f Dr a new ermanent California ID number as a hazardous waste: ❑ Generator ❑Transporter <br /> Reason for new n ber: ❑ Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed <br /> If your business generates Brea r than 100 kg of RCRA hazardous waste per month,contact US EPA for a federal ID number. <br /> Changes to Status nfo ' nor an Existine ID Number. (See instructions) <br /> For existing ID number: C i L _ _ _ _ _ _ _ _ _ <br /> ❑ 2. I am updating tl ie mailin address and/or contact information only. <br /> ❑ 3. I am inactivatin Y this ID 4urnber. <br /> ❑ 4. 1 am reactivatin this ID umber. <br /> ❑ 5. 1 am changing the businel s name. There has been no ownership change. <br /> (See instructions) <br /> 6. Site/Facility/Business Name(Include DBA): <br /> 7. Site Location: <br /> Street <br /> ity State Zip County <br /> 8.(a)Federal Employer ID Nur iber: (b)Board of Equalization Fee Account Number: <br /> (b)is only required from generators of greater than 5 tons per calendar year.) <br /> (See instructions.) <br /> 9. Mailing Address: <br /> Street <br /> ity State Zip <br /> (See instructions.) <br /> 10. Site Contact Person: <br /> First Name Last Name <br /> Contact Person A dress: <br /> Street <br /> city State Zip <br /> Contact Person PI one Number: Fax Number: (� <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business EiAddress: <br /> Preferred Prim Commu�al <br /> cation: ❑ Mail ❑ Email <br /> (See instructions.) <br /> 11. Legal Business C wner(nol property owner): <br /> Name <br /> Owner Address: _ <br /> Se City State Z i p <br /> Owner Phone Nt tuber: Fax Number: (� <br /> Are Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Classif cation(SIC)Code for the Site: (4-Digit Number) (See instructions.) <br /> DTSC Form 1358(5/07) www.dtsc.ca.gov <br />