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,State of Cslifomia-California Environmental Protection Agency <br /> Reset FOrm • Department of Toxic Substances Control-GISS <br /> Print P.O.Box 806,Sacramento,CA 95812-0808 <br /> CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br /> Please type or neatly print In ink. Please review the line-by-line <br /> To check on the status of our request. o to www.hwts.dtsraotv antl dick on Re refuto. <br /> [NE_WNUMt$t:KREQUES,Q Check all that apply. <br /> 1. I am applying for a new permanent California ID number as a hazardous waste: @ Generator ❑Transporter instructions.) <br /> eason for new number: A. <br /> Never had a number <br /> B. <br /> ou business generates greater t❑han 100 kg of RCRA hazardous waste per Business ovedmonth, C. <br /> Z Legal <br /> EPA for a federal ID number.changed <br /> Eln <br /> 70 STATOR AN EXISTING ID NUMBER <br /> ID number. C A (See instructions.) <br /> pdating the mailing address and/or contact information only. <br /> nactivating this ID Number. <br /> eactivating this ID Number. <br /> hanging the business name only, no ownership change. <br /> F <br /> Facility/Business Name(include DBA): LATHROP CHEVRON (See instruct ons.) <br /> Location: 140E LATHROP ROAD <br /> street <br /> LAT y CA 95330 SAN JOAQUIN <br /> City State Zip County <br /> deral Employer ID Number <br /> --__ _ Board of Equalization Fee Account Number <br /> ((b)!s only required from generators of greater than 5 to <br /> per calendar year) <br /> 9. Mailing Address: 140E Lathrop Road (See instructions.) <br /> Street <br /> Lathrop <br /> City State 95330 <br /> Zlp <br /> 10. Site7ContactPerson: Shamsuddin Faqiryan (See instructions.) <br /> Last Name <br /> Conon Address: 140E Lathrop Road <br /> Street <br /> Lathrop CA 95330 <br /> city State <br /> Zip <br /> Contact Person Phone Number. ( 07 1 592-9137 Fax Number: ��9 20 982-5779 <br /> Area Code Phone Number <br /> Area Code Fax Number <br /> Contact Person Business Email Address: lathropchevron@gmail.com <br /> Preferred Primary Communication:QMall ❑Email <br /> ='erAddress: <br /> (not property owner): Piedmont Petroleum Company INC (See instructions.) <br /> Lathrop Road NameLathropreetCA 95330 <br /> 707 592-9137 city <br /> State Zip <br /> C_- Fax Number. ( 209 ) 982-5779 <br /> Area Cade one Number Area Code F <br /> ax Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: 5 5 4 1 ( -Digit Number) <br /> — — (See instructions.) <br /> 13. Certification: I certify under penalty of law that the information on this document was prepared to the best of my knowledge and <br /> belief to be, true, ccurate and complete. <br /> SIGNATURE��f,✓ 'rr//l �Lo DATE <br /> NAME(print) cC..lJ'/4',Er�rq (" •r r efr TLE �L(,� r <br /> —__ l �`.7'�tT t ✓{ E i� PHONES <br /> DTSC Form 1358(8108) <br />