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06/25/2008 10:24 925--827-4918 rat+e.n nirru n or.ao • --- <br /> Depo��nt of Toxic Substances Control-GISS IVEQ <br /> State of California-Cellfomia.Euvirmmoa.werntection Agency EEW7?� <br /> Sacramento.CA <br /> ,l�i+l � 52008 <br /> California Hazardous Waste Permanent ID Number Application �alUduAuwrvwunlr <br /> I'le:are type nr rtea ly print in inti civthe line-bl-line htstntaiornr carefully. <br /> To elaock un the stems of our request, oto ww svts. ca. ov and olick on R arts. DFFICE OF EMERGENCY 8 ` <br /> part inarrvurinnr.J <br /> IVow Number ReaU4St4 Check all that apply. <br /> ❑ I. I am applying for a new prnnanent.California ID number as a hazardous waste: 0 Generator O Transporter <br /> Reason far new number: A. a Never had a number B. ❑ Business moved C. O Legal.owner of business changed <br /> 1fyour buxinsss generates r� carr+'than 100 kg of NCHA hazardous warrc per+nonrh, contact U.S El'A for a federal ID number. <br /> 7D3. <br /> to Stator or IntMVatiun rs v an Exlstins TD Number. <br /> (See im(mcdonm,) <br /> ing TD number. CA — _ — .— — -- - - <br /> zm updating the mailing address and/or contact information only. <br /> minactivatingthisIDNumber.m reactivating Ibis ID Number. <br /> 0 5. f am changing the tusintws name. 'Phare has been no ownership change. <br /> (See insrructions.) <br /> 6. Site/Fa:illty/Business Vame(.Include DBA): FLAG CITY_CHEVRON <br /> 7. Site Location: 6 4 2 L G DLII+—A --------- •----- <br /> Street CA 95242 SAN JOA UIN <br /> _ TADI __ —.�._......-- ---- <br /> C .� zue!114g Mstaec --— Up county KH <br /> —goo 9U4a9� <br /> 8. (a)Federal Employer ID Number:?- (b)Board of Equalization Fee Account NumbccSA <br /> - (b) is arrl) ra0uired.fromerreratnns a <br /> greater than S fans per calendar yr-ar.) <br /> --—-w_-�.-.-- (See instructions,) <br /> 9. Mailing Address: P.O.BOX 5728 <br /> Street <br /> CONCORDCA 94523 — <br /> City <br /> Srate Zip - <br /> (Sce instructions.) <br /> 10. SiteComaaPersnn: ALI AMIRI <br /> Fint Name Lost Name <br /> Contact Person Addrna: _6421 CAPITAL AVE <br /> $erecr <br /> 1,ODI CA 95242 <br /> City Slate Zip <br /> Contact Person Phone Number: 925 360_8176 Fax Number. ( 925 687-4122 <br /> Arco Code Phone Number Area Code Fax Number <br /> Contact Person Susir ess Email Address:N/A <br /> Preferred Primary Communication: 0 Mail 0 Email <br /> —_ (See inttructiond.) <br /> 11. Legal Business Owni:r(not property owner): HALEHAM_ITU / KIUMARS E. KHAJFVANDI <br /> Name <br /> Owner Address: 61 CHILPANCINGO PKWY#201 `— PLEASANT Ill CA 94523.1300 <br /> Street — City State Zip <br /> Owner PhoneNumbf:r: ( 25687.4480 Fax Number: (925 ) 687-4122 <br /> Area Code Phone Number Arco Code Fax Number <br /> 12. Standard Industrial Ciassifreation(SIC)Cade for the Site: 5 5 4 ] (4-Digit Number) (See fivawctians)� <br /> DTSC Form 1358 (5107) — — www.dtsc.cm.gov <br />