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Jan 28 g9 04:33p Anwar Faquirya* <br /> 14466450 <br /> - Slate of California-California Environmental PfotAgencyon Agency p 1 <br /> - Papa nment of a ToxicSubstances Control-GIGS <br /> P.O.Box 7306,Sacramento.CA 95872.0806 <br /> CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br /> Please type or neatly print in Ink. Please review the the-by-line inslruclions carefully. <br /> To check on the status of nue re uest oto www.hwis.dtse.ca. ov and click on Reports. <br /> NEW NUMBER REQUESTS Cheek all etatapply. <br /> Q 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator GTTransporeir rnstrucfions,) <br /> Reason for new number: A. 21 Neverhad a number B. Q Business moved C. Q Legal owner of business changed <br /> !f your business generates greater than 100 kg of RCRA hazardous waste per month, confec!US EPA for a federal/D number. <br /> C ANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER <br /> For existing ID number: C A (See instructions.) <br /> 2. 1 am updating the mailing address andlor contact information only. <br /> 3. 1 am inactivating this ID Number. <br /> ❑ 4. 1 am reactivating this ID Number. <br /> J 0 5. 1 am changing the business name only, no ownership change. <br /> 8. Site/Facility/Business Name(Include DBA): Lathrop Chevron (See instructions.) <br /> 7. Site Location: 140 Lathrop Road <br /> Street <br /> Lathrop CA 95330 San Jaaouin <br /> City State <br /> 8.(a)Federal Employer ID Number Zip County <br /> Board of Equalization Fee Account Number <br /> ((b)is only required from generators of greeter than 5 tons per calendar year. <br /> 9. Mailing Address: 140 Lathrop Road (See insWctions.) <br /> Street <br /> Lathrop CA 95330 <br /> Crt State <br /> Zip <br /> 10. Site Contact Person: Dean Faquiryan (See instructions.) <br /> First Name Last Name <br /> Contact Person Address: 140 Lathrop Road <br /> Street <br /> Lathrop CA 95330 <br /> City State <br /> Zip <br /> Contact Person Phone Number: ( 707 ) 592-9137 Fax Number: ( 209 ) 982-5779 <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address lathropchevron@gmail.com <br /> Preferretl Primary Communiation:OMail QEmail <br /> It. Legal Business Owner(not property owner): ShamSUddin Faquiryan (See instructions.) <br /> Owner Address: 5248 Windin Way Nemo Vacaville <br /> street CA 95688 <br /> Owner Phone Number: ( 707 ) 592-9137 Cry state Zip <br /> Fax Number. ( 707 1693-6779 <br /> Area Code Phono Number Area Code Fax Number <br /> 12 Standard Industrial Classification(SIC)Code for the Site: <br /> (4-Digit Number) (See instructions.) <br /> EDm-rSC <br /> tification: I ttRif//under penalty of law that the information on this document was prepared to the best of my knowledge end <br /> ief to be,true, t5curate and comp! fe. p <br /> URE DATE I <br /> Pring - ITLE_�` I' / ���� PHONE 5L21Z �'�1� ( <br /> rm 1358(VDII) <br />