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Jan 28 09 04:33p Anwar Faquiryan 1-046-6450 p,1 State of California-California Environmeita cloctlon Agency Departmentof Toxic Substances Control-GISS P.O.Box 806.Sacramento.CA 95612-0806 CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or neatly print in ink. Please reviewthe Ine-by-line Instruction carefuln,. To check on tha status of your request,go to www.hms.dtsc.ca, ov and click on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) 1. 1 am applying for a new permanent California ID number as a hazardous waste. ❑ Generator ❑Transporter Reason for new number: A, 21 Never hada number B. ❑✓ Business moved C. Q Legal owner of business changed If your business generates greater then 100 kg of RCRA hazardous waste per moth, confect US EPA for a federal IO number. CHANGES TO STATUS OR INFORMATION FORAM EXISTING ID NUMBER (See instructions.) For existing ID number: C A _ ❑ 2. 1 am updating the mailing address and;or contact information only. r1 3. 1 am inactivating this ID Number. ❑ 4. 1 am reactivating this ID Number. 10 5. t am changing the business name only, no ownership change. B. SLathrop Chevron (See instructions.) de/FadlitylBusirtess Name (include DBA): P 7. Site Location: 140 Lathrop Road Street Lathrop CA 95330 San Joaquin city State Zip County B.(a)Federal Employer ID Number _-. .,,___ Board of Equalization Fee Account Number ((b)is only required from generators of greater then 5 tons per calendar year) ff Address. 140 Lathrop Road (See instructions.) Street Lathrop CA 95330 Gty Stale Zip 10. Site Contact Person: Dean Faquiryan (See instructions.) First Name Last Name Contact Person Address: 140 Lathrop Road Street Lathrop CA 95330 city Stale Zip ��7. q Contact Person Phone Number: L 707 ) 592-9137 Fax Number: ( 209 ) 982-5679 Arca Code Phone Number Area Code Fax Number Contact Person Business Email Address: Iathropchevron@gmail.com Preferred PrimaryCommunica}ion:OMail !❑Ercall 11. Legal Business Owner(not property ouer): Shamsuddin Fa ui�an (See instructions.) Name Owner Address: 5248 Winding Wav Vacaville CA 95688 Street City Slate Zip Owner Phone Number: ( 707 ) 592-9137 Fax Number. ( 707 ) 693.8779 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 certi6 under penefly of law that(he information on this document was prepared to the best of my knowledge and belief ro be,true, curate and comp; to. ry SIGNATURE �----� DATE_I` NAME(print) fl.TITLE P in PHONE ' O';c —�Cf�9/j7 DTSC Form 1356(6r08)