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State of California - California Environment, { otection Agency Department of Toxic Substances Control - GISS <br />�w ,P.O. Box 806, Sacramento, CA 95812-0806 <br />Reset Form Print <br />CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br />please m,.a or neat]. print in ink. Please review the line -by-line instructions carefully. <br />To check on the status of your request go to and dick on Reports. <br />NEW NUMBER REQUESTS Check all that apply. (See instructions.) <br />❑r 1. 1 am applying for a new permanent California ID number as a hazardous waste: 0 Generator []Transporter <br />Reason for new number. A. 0 Never had a number B. ❑Business moved . C, ❑ Legal owner of business changed <br />If your business generates greater than 100 kg of RCRA hazardous waste per month,- contact US EPA for a federal ID number. <br />CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) <br />For existing ID number: C A -L-- _Q -0- -a a 4-4 -7— <br />❑ 2. 1 am updating the mailing address and/or contact information only. <br />❑ 3. 1 am inactivating this ID Number. <br />❑ 4. 1 am reactivating this ID Number. <br />❑ 5. 1 am changing the business name only, no ownership change. <br />6. Site/Facility/Business Name (Include DBA): <br />7. Site Location: 8932 E. Hwy 12 <br />Street <br />Victor <br />8. (a) Federal Employer <br />Ted's Welding & Repair <br />(See instructions.) <br />Ca 95253 San Joaquin <br />State Zip County <br />Board of Equalization Fee Account Number <br />�) is only required from generators of greater than 5 tons per calendar year.) <br />(See instructions.) <br />9. Mailing Address: PO Box 726 <br />Street <br />Victor Ca 95253 <br />City State Zip <br />10. Site Contact Person: <br />Bill Braun (See instructions.) <br />First Name Last Name <br />Contact Person Address: 8832 E. Hwy 12 <br />Street <br />Victor Ca 95253 <br />City, - Slate Zip <br />Contact Person Phone Number:2( O9) 603-8979 Fax Number:2( 09) 368-9864 <br />Area Code Phone Number Area Code Fax Number <br />Contact Person Business Email Address: tedsweld@comcast.net Preferred PrimaryCommunication: <br />❑Mail ❑✓ Email <br />11. Legal Business Owner (not property owner): <br />Bill Braun - (See instructions.) <br />Name <br />Owner Address: 8832 E. Hwv 12 Victor CA 95253 <br />Street - City State • Zip <br />Owner Phone Number:2( O9 ) 603-8979 Fax Number:2( O9) 368-9864 <br />Area Code Phone Number Area Code Fax Number <br />12. Standard Industrial Classification (SIC) Code for the Site: 2 8 7 6 <br />13. Certification: I certify under penalty of law the 7e, <br />ation on this document was prepared to the best of my knowledge and <br />belief to be, true, acpwu nd complete. SIGNATURE _ p DATE <br />NAME (print) TITLE eDW ArCK PHO E 6 <br />