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State of California-California Environmenietection Agency Opartment of Toxic Substances Control-GISS Reset FOfm PfIDt P.G.Box 806,Sacramento,CA 95812-0806 CALIFORNIA HAZARDOUS WASTE PERMANENT 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. I am applying for a new permanent California ID number as a hazardous waste: ,enerator Transporter Reason for new number: A. ever had a number B. ❑ Business moved C. ❑ Legal owner of business changed If your business generates greater than 100 kg of RCRA hazardous waste per month,contact US EPA for a federal ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) For existing ID number: C A_ ❑ 2. lam updating the mailing address and/or contact information only. ❑ 3. lam inactivating this ID Number. ❑ 4. lam reactivating this ID Number. ❑ 5. lam changing the business name only, no ownership change. 6. Site/Facility/Business Na/me/(Include DBA): S r( (�Gj �f/(f� ��/6 (See instructions.) 7. Site Location: — ��1 /� /(J • -7,�,U/ s— Z� T� City State Zip ounty 8. (a)Federal Employer ID Number-S E6 /1.5 7)., Board of Equalization Fee Account Number ((b)is only required from generators of greater than 5 tons per calendar year.) 9. Mailing Address: �S MG (See instructions.) Street City State.. Zip 10. site Contact Person: R'/� � (See instructions.) _ /�iC/P/��A/l� != V First Namme Last Name i Contact Person Address: 4 s% stSt�LK/l/rU e X14 f City State State Zip Contact Person Phone Number: C ,�/��`yY�� Fax Number: �) Area ode Phone Number Area Code Fax Number Contact Person Business Email Address: 4 6 / .N&/• Preferred Primary Communication:[Mail ❑Email 11. Legal Business Owner(not property owner): r�aS PMPj'}Ual lee instructions.) Owner Address: SJR. t%d[1CIU.{/ �// �S G Street Owner Phone Number: u!! J2 G/- �,/�/�� FaxCity Slate Zip Number: (_) Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: _ _ _ _ (4-Digit Number) (See instructions.) 13. Certification: I ce i under p ally of law that the info atiomon this document was prepared to the best of my knowledge and belief to be,tru ccurate d complete. SIGNATURE DATE_y .L�61- 5 NAME(Print) 7� �'` LE a/ti=2 PHONE aj�;y-d67,(7 DTSC Form 1358(6/08) 7