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03/02/04 O1:17pm P. 004 <br />DoPart:ncnt of Toxic Snbstmres Control <br />of Califomla – CalifIv-In BnvironmentAl PYOLdCtirJn Agency P.O- Box SD6 <br />Sacramento, CA 95812-0806 <br />California Hazardous Waste Permanent ID Number Appiscstiost <br />Please revrew the line -byline instructions carefidly and compleze all items on the application <br />New Number Requests. Checic all that apply. Generator <br />] j, 1 am applying for anew permanent California ID number as a'gusiness moved <br />Reason for new number: A. Never had a number B- [ ] <br />Chances t tatus pr leformation, <br />For ID number: C A— <br />(] 2• lam updating the mailin, address and(or contact information oniy. <br />(j 3- 1 am inactivating this ID Number• <br />(] q, 1 ant reactivating this IDNumber. <br />T r t t — chanQine the business name- There_ has been no owlelship ci <br />10. Site Contact Person: <br />(See instmetions) <br />Transporter <br />C- [] Legal owner of bnSlncsS changed <br />Contact Person Address:.. <br />Street = f� <br />Ctry Zip <br />Fax Number: <br />Contact Person Phone dumber:--- Area Code Fax Number <br />Arca Code Phonc Number <br />Contact Parson Business Email Address' Mail <br />arcferred PriMMY Communication' fat ---- <br />DISC 1358 10/03 <br />