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Slate df California-California Environmental 4eclion Agency *apartment of Toxic Substances Control-GISS Reset Form Prl nt"'A,11 P.D.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. 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 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 nQ 0_ Q 1 _0- ❑ 2. 1 am updating the mailing address and/or contact information only. ❑ 3. 1 am inactivating this ID Number. /Ip t0 4. I am reactivating this ID Number. ❑ 5. 1 am changing the business name only, no ownership change. od ` r (See instructions.) 6. Site/Facility/Business Name(include DBA): Alp\np M ,�a xrt Paargi ng cgip'gan" Tnr- 7. Site Location: 9900 Lower Sacramento Rd. St&Ft ton CA 95210 San Joaquin City State Zip County 8. (a)Federal Employer ID Number94- Board of Equalization Fee Account Number ((b)is only required from generators of greater than 5 tons per calendar year.) 9. Mailing Address: 9900 Lower Sacramento Rd. (See instructions.) Street 95210 � oiu sten CA — - Cdy , Slate Zip 10. Site Contact Person: Alice Kae s l i n (See instructions.) First Name Last Name Contact Person Address: 9900 Lower Sacramento Rd. Street 95210 Stockton CA City Slate Zip Contact Person Phone Number: ( 209)477-2691 x 2 4 5_ Fax Number: X209) 477-1994 Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: a1ice @a 1pi nemeats.COmeferred Primary Communication:®Mail El Email (See instructions.) 11. Legal Business Owner not property owner): shareholders Name Owner Address: 9900 Lower Sacramento Rd. Stockton A 9421 D Street City State IZip Owner Phone Number: (2.0.4477-269_1 Fax Number. ( 209) 477-1994 Area Code Phone Number Area Code Fax Number 12 Standard Industrial Classification(SIC)Code for the Site: 2 Q _L _3_ (4-Digit Number) (See instructions.) 13. Certification: I 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" t . SIGNATURE t U—, l DATE 0 NAME(print) A i t cL C 4(,'S tTITLE .$ alrt PHONE X rl¢5 DTSC Form 1358(6/08)