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Mai 03 20 04: 56p r"STLRND 803 12 9412907 p. 2 <br /> 95/01/2007 15:09 20946 —'S ENVIRONMENTAL HFALTH PAGE 05/05 <br /> Statc of Calif)mia-Californic 0nvi o mefiu;protection Agency <br /> Department of Toxic Suhstences Control <br /> clss <br /> P-0 Box 806 <br /> S-rnhcnta CA 9$812.0906 <br /> CAIifornia Hr,asrdOUS Waste Permanent IID Nam ber Application <br /> Ph ace review the link-byline Wirucriont carefully. <br /> ��Ucllru-,ni <br /> rr Yleggcscs, Check all that:pply.pplying fora naw perm neer califarnia lt)n� (See instructions)mbct as a harntdous waste; leGenerator ;�Ttansportcr�F27s to for new number. q. ever had 8 rnrmber B. L'. Business rROved G. d 1 egai owner of businew changed <br /> �— <br /> an la';�tttusol_Infonoatian <br /> For ID nun;tit C 4 _ (See insrrncriois,) <br /> am ul,dating the tRailift�address a tdlor contact infprn+AtiOn only, <br /> 1 3 1 am ir�,activating this JD Number. <br /> 4. J am tracdvatingthis lb Number, <br /> am G anging the busilcss name. 7 here has been no ownership change, <br /> 6. This site f; a: -- <br /> � ncrator of la r than 1,000 lcg/month Cali.fomia•only waSfe <br /> D Generator of gre iter than 1,000 kg/month California-only waste instrucrtons,) <br /> ❑ Condi6en2lly a(erupt Sm 11 Qua,.tity Gcncratur of RCiL4 Waste, <br /> 7, Site/Faciliiy Name: <br /> R. Sit t-oaxt:an! <br /> Sheet L <br /> — City genre <br /> ziR County <br /> �1 <br /> 9, Mailing A dress: <br /> (See insrrercrions,) <br /> street <br /> +_ - QC'� <br /> _ State 1p <br /> 10. Site Con(LI t Person: (Sae irtffrucrions,) <br /> !•first Namc Last Name <br /> Contac Yci ton Address: <br /> Cir state Zip <br /> COMM Pe tOn Phone Number: ( �D(p yGI-` <br /> Pax Nurnber: ft b <br /> Are i Code Phone Number A,ca Code Fax Number <br /> 7 <br /> vy� y� 7 x3 <br /> C4rttpGt Pe son Business E;nail Ad-ddress '7 <br /> Preferred J' lication: _l 1Qa[l p Email "'� <br /> I l.. Legal Susi-css Owner(n(t property ow,er): � _ L {r ,/ <br /> =� 1r (See irrsrrucrfons,) <br /> L ��L"Cr es5; !1 ]—c Number: C(� _�� c,�� City Statc Zip <br /> req Code phonei`j,tuber <br /> 12. standard]n:lustrial Classifi�suion(S1C)('ode for the gjte: r , <br /> —�� _ O. (4-Digitlvumber (yes insPlvcrinns) <br /> DTSC Form J3:,8(9/o4) !�__ <br />