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State of California — California Environmental Protection Agency Department of Toxic Substances Control - HWMP P. O. Box 806 , Sacramento, CA 95812-0806 PERMANENT STATE 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 www.hwts .dtsc.ca . ov and click on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) ❑ 1 . 1 am applying for anew permanent California ID number as a hazardous waste: ❑ Generator ❑ Transporter Reason for new number: A. ❑ Never hada number B. ❑ Business moved C. ❑ Le towner of business changed If your business generates greater than 900 kg of RCRA hazardous waste other than those hazafdous waste listed in 40 CFR 269 . 5 subparts (c) and (d), per month, complete Form 8700- 92 for an EPA (federal) ID number , / CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER (See instructions.) For existing ID number: C A L Q 0 (> 9 1 1 '1 ❑ 2 . 1 am updating the mailing address and/or contact information only. ❑ 3 . 1 am inactivating this ID number. EZ'4 . I 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) : SD . U� �- D6 � 7. Site Location: Later �j 0 � - 12 Street City State Zip County 8 . (a) Federal Employer ID Number " j lip - 01 `1; Bvi (b) Board of Equalization Fee Account Number b is only required from generators of greater than 5 tons per calendar ear. (See instructions.) 9 . Mailing Address: 10 Street 1, ;_ rr CR 0\ 52 City State Zip (See instructions.) 10. Site Contact Person : _ First Name Last Name Contact Person Address: \ W C ti Street cps C City �q State Zip Contact Person Phone Number: �^ ) t,? ol cA1 9k Fax Number: ( ) Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: Preferred Primary Communication: ❑ Mail Email (See instructions.) 11 . Legal Business Owner (not property owner): LEE First Nam Last Name Owner Address: vcctfmc la tree` W Ck23� City 2cp( _ (00 t ~ ZZck State Zip Owner Phone Number. ( ) Fax Number: ) Area Code Phone Number Area Code Fax Number (See instructions.) 12. Standard Industrial Classification (SIC) Code for the Site: S L 1 (4-Digit Number) (See instructions.) 13. Certification : I certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to be, true, a urate and complete. SIGNATURE �J C I DATE 3 ~ 22 Z3 NAME ( print) t-�`�1 J Q`n TITLE PHONE DTSC 1358 (5/29/15)