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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 http:i*ww.hwts,dtsc.ce.gov and click on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) O 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑Transporter Reason for new number: A. ❑ Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed If your business generates greater than 100 kg of RCRA hazardous waste other than those hazardous waste listed in 40 CFR 261.5 subparts(c)and(d),per month, complete Form 8700-12 furan EPA(federal)ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER (See instructions.) For existing ID number: CA L 0 0 0 3 9 7 0 2 5 ❑ 2. 1 am updating the mailing address and/or contact information only. ❑ 3. 1 am inactivating this ID Number. 21 4. 1 am reactivating this ID Number. Reason(please select one): A. 0 Verification Questionnaire B. ❑ Other ❑ 5. 1 am changing the business name only,no ownership change. (See instructions.) 6. Site/Facility/Business Name(Include DBA): GEMCO RIPON TRUCK PLAZA 7. Site Location: 1022 E FRONTAGE ROAD Street RIPON CA 95366 SAN JOAQUIN City State Zip County 8.(a)Federal Employer ID Number (b)Board of Equalization Fee Account Number 44052138 ((b)is only required from generators of greater than 5 tons per calendar year.) (See instructions.) 9. Mailing Address: 1022 E FRONTAGE ROAD Street RIPON CA 95366 city State ZIP (See instructions.) 10. Site Contact Person: KULWINDER JOHAL First Name Last Name Contact Person Address: 1022 E FRONTAGE ROAD Street RIPON CA 95366 city State Zip Contact Person Phone Number: ( 209) 541-8190 Fax Number. ( 209 )599-7561 Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: freightexpertS7(a),yahoo.com Preferred Primary Communication: ❑ Mail ca Email 11. Legal Business Owner(not property owner): GEMCO RIPON TRUCK PLAZA INC (See instructions.) Name Owner Address: 1022 E FRONTAGE ROAD RIPON CA 95366 Street City State Zip Owner Phone Number: ( 209 1541-8190 Fax Number. ( 209 1 599-7561 Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification (SIC)Code for the Site: 9 9 0 0 (4-Digit Number) (See instructions.) 13. Certification: 1 certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to be,true, accurate and comp �� SIGNATURE DATE 07/27/2018 NAME(print) KULWINDER S JOHAL TITLE CEO PHONE 209-541-8190 DTSC Form 1358(01117)