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09/21/2009 11: 49 12093341373 FLAGCITV CHEVRON PAGE 04112 <br /> ~05/15/2019 09:33 7.2093241E FLAGOITy CHEVROFI eltte+j. <br /> Depsrtmont of Tvxie 9ubstaneRa Control•©189 <br /> State of GAllfomla—Calibrnla Environmental Protection Ag®noY p,0,sox 806,Oacrampnte,CA 95812-0806 <br /> a f h OEM <br /> CALIFORNIA HAZARPOUS WASTE PERMANENT ID NUMBER APPLICATION <br /> p+(�aae type or neatly print In inl(, please rrsvlew the lir+®-by-10AoInstruct onA carefully. <br /> To chee On the A ua of Ljj regties t�b0 to rtNw tlwts dts� (see instructions.) <br /> 7=; Rn <br /> UESTS Chcolc all ih:+t applY <br /> FICA for a now pprm2nent California 10 numberas a hozardauawaste: Iden®rater Q7r�nsportEr <br /> s changed <br /> number: A, ❑ Never had a numberBusiness moved C. Legal owner o f�darAl�D numbernerates greater rhAn 100 Ice of RCRA hazardous wa.�'te per monttl, contact t15 C t3 <br /> CtiA G S TO STATUS IN TIO OR EXIS N Ia NU ER <br /> •- '�•�'^•' (SGC Instructions.) <br /> For exlating 10 number- C <br /> (� 2. 1 am updating the mallintl Address andlor contact information only, <br /> SAC. R,T: ,+.^"'".� �In� <br /> [1 3, 1 nm inactivating this ID Number. <br /> ❑ 4, 1 am reactivating this ID Number. <br /> 5, 1 am changing the business name only, no ownership change. <br /> (Sce i"StruCfr�r+s.) <br /> 6. Site/Facility/Business Nam�ee(Includn DSA): <br /> 7. site Location; 2 2— <br /> Mr of Q'A <br /> P ' Jtoto llr� County <br /> City 1 Board o�Fquallzation Fee Ac�:ount Number <br /> 6.(a)Federal Employer tD Number �r - 4.91 equirc#onr 9e� i 9- f atpr°tb n 5 tons Cr calendar year, <br /> (s&o instructions.) a'� <br /> 9. Mailing Address: I �� <br /> steeet <br /> Clt <br /> �•- State +p <br /> (See Instructions,) <br /> 10. Site Contact Pomon: _t�1 J 5 k� !f <br /> First <br /> Name Last Name <br /> Contact Person Addreo,3: L <br /> State Zip <br /> City �,,� 3 �-1 <br /> —� Fax Number: (.ICA 3!1�, <br /> ContPct Peraon Phone Number. Area o Pnnno NumbAr Area Code Pox Number <br /> pr ornnlunicatlon'©Mail 0 Emolt <br /> Gonta on Business Email AddrrsD' . <br /> W —'~ (See Instructions.) <br /> owner): <br /> l4 V—!r <br /> 11, Legal Business Owner(not property Name '� Z. <br /> ��� G.p <br /> Owner Addross: Strot d city State <br /> -j, ^� p 73 Fax Number; ( � <br /> Owner Phone Number: (���I )� Area C dp I'ax Dumber <br /> Area Cade Phone Number <br /> 12. Standard Industrl�tl Classification(SIO)Code for the Site; — <br /> �4-Dlglt Number) Sco Instructions. <br /> 13, Certification: I eertlty undethe information on this document was prepared to the best of my knowledge end <br /> belief to be,true,aceur t�L �o <br /> DATE <br /> SIGNATURE _ <br /> TITLE � E <br /> NAME(prink) 0-'/1� t2J� r�W�� (� <br /> 4 SC Form 1368(6108) <br />