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State of California-California Environmental Protection Agency Department of Toxic Substances Control-GISS Reset Pri P.O.Box 806,Sacramento,CA 95812-0806 Form nt 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.gov and click on Reports. NEW NUMBER REQUESTS Check all that apply. (See instructions.) applying for a new permanent California ID number as a hazardous waste: [B/Generator E]Transporter Reason for new number: A. ever 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 ❑ 2. lam updating the mailing address and/or contact information only. ❑ 3. 1 am inactivating this ID Number. ❑ 4. 1 am reactivating this ID Number. ❑ 5. 1 am changing the business name only, no ownership change. (See instructions.) 6. Site/Facility/Business Name(Include DBA): LI JA I°C_ 7. Site Location: DI)I)A - 7fz- CV 76 Street-Tr nC r � required from generators of greater than 5 tons per calendar year.) (See instructions.) 9. Mailing Address: Street City State Zip �s / (See instructions.) 10. Site Contact Person: - I U � ^S� l C-7�LLr First Name Last Name l� Contact Person Address: )4)-0 �V (/=j P-W- L 1 �1 Street CA Cl t-51931 City �) /j �//� �jState q Zip Contact Person Phone Number: (9m) "-1g-' !` - 5 Fax Number: (L) /) Area Code Phone Number Area Code Fax Numberw,/ Contact Person Business Email Address: Preferred Primary Communication: 4il ❑Email 11. Legal Business Owner(not p notproperiy owner): J) VrE ILL (See instructions.) Owner Address: ?_I � Name �J n P7U (_ N� i� h r)-o f / Stre /y I City KStliate Kziip� Owner Phone Number: ( ) -I � r7 44 Fax Number: (� Area Code Phone Number Area Code Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: 1 (4-Digit Number) (See instructions.) 13. Certification: I certify under penalty of law t at the information on this document was prepared to the best of my knowledge and belief to be,tru accurate a d cc p to SIGNATURE r% DATE ` ,( NAME(print) 7J� LSE't Cif Z-L- TITLE- k) PHONE Lf!� `1- 7145 DTSC Form 1358(6/08)