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0 <br /> State of California–California Environmental Protection Agency Department of Toxic Substances Control <br /> P.O.Box 806 <br /> Sacramento,CA 95812-0806 <br /> California Hazardous Waste Permanent ID Number Application <br /> Please review the line-by-line instructions carefully and complete all items on the application. <br /> New Number Requests. Check all that apply. (See instructions) <br /> I am applying for a new permanent California ID number as a: [] Generator [] Transporter <br /> Reason for new number: A. (] Never had a number B.[] Business moved C. [] Legal owner of business changed <br /> Changes to Status or Information (See instructions) <br /> For ID number: CA _ _ _ <br /> [] 2. lam updating the mailing address_and/or_co_ntact information only. <br /> [] 3. lam inactivating this ID Number. <br /> [] 4. lam reactivating this ID Number. <br /> [] 5. lam changing the business name. There has been no ownership change. <br /> 6. This site is a: [] Conditionally Exempt Small Quantity Generator of RCRA Waste (See instructions) <br /> [] Generator of less than 1,000 kg/month California-only,waste .' <br /> (] Generator of greater than 1,000 kg/month California-only waste[ <br /> 7. Site/Facility Name: <br /> 8. Site Location: <br /> Street <br /> City State Zip County <br /> 9. Mailing Address: <br /> (See instructions) <br /> Street <br /> City State Zip <br /> 10. Site Contact Person: (See instructions) <br /> First Name Last Name <br /> Contact Person Address: <br /> Street_ <br /> City State Zip <br /> Contact Person Phone Number: C—, Fax Number: �) <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address: <br /> Preferred Primary Communication: [] Mail (] Email <br /> 11. Legal Business Owner(not property owner): (See instructions) <br /> Name <br /> Owner Address: <br /> Street City State Zip <br /> Owner Phone Number: <br /> Area Code Phone Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: (4-Digit Number) (See instructions.) <br /> DTSC 1358 10/03 <br />