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Fwd <br />Department of Toxic Substances Control <br />State of Califomia— Califomia Environmerl Protection Agency P.O. Box 806 <br />Sacramento, CA 95812-0806 <br />California IIazardous Waste Permanent ID Number Application <br />Please review the line -by -fine instructions carefidly and complete all items on the application. <br />- (See instructions.) <br />r Number Re uests. Check all that apply. Generator Trans orter <br />] 1. I am applying for a new permanent <br />Call <br />ID number as a: [ ] [ ] P <br />Reason for new number: A. ,Never had a number B. [ ] Business moved C. [ ] Legal owner of business changed <br />(See instructions.) <br />Chanes to Status ar Information. <br />— <br />[ J 2. i ant updating the mailing address and/or contact information only. <br />[ J 3. I am inactivating this ID Number. <br />(] 4. 1 am reactivating this ID Number. <br />[ ] 5. I am changing the business name. There has been no ownership change. <br />6. '[itis site is a: Conditionally Exempt Small Quantity Generator of RCRA Warta <br />See instructions.) <br />Generator of less than 1,000 kgimonth California -only waste <br />Generator of greater than 1,000 It month California -only waste <br />C� s /rj (ART <br />7. Site/Facility Name: EDlt67, <br />8. Site Location: 146& (P a— - <br />Street _ __ n a X37 —Col vPP�ljrs~ <br />��//��.,, (See instructions.) <br />� <br />9. Mailing Address: -ip <br />Street <br />COCk2��'rC0 (�1 <br />r:�. State Zip <br />10. Site Contact Person: <br />Contact Person Address: <br />RLAPIrJ <br />Or <br />City State Zip <br />(See imtnretions) <br />Contact Person Phone Number. (CD4) Ste/' I — S57 b Fax Number. () Acode <br />rea � Number <br />Area Code Phone Number <br />Contact Person Business Email <br />(See instructions.) <br />n / /� A <br />11. Legal Business owner (not property owner): Name �S3 p <br />owner Address: :;kZ-7 <br />Ciry State Zip <br />Street <br />owner Phone Number: (�() <br />DISC 1358 10103 <br />