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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 /> PQ 1. I am applying for a new permanent California ID number as a: X Generator [] Transporter <br /> Reason for new number: A. )Q 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: C A <br /> [] 2. I am updating the mailing address and/or contact information only. <br /> [] 3. I am inactivating this ID Number. <br /> [] 4. I am reactivating this ID Number. <br /> [] 5. I am 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 /> pQ 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: -9 H,�_7 L L P/Z 0 1 /A/L • <br /> 8. Site Location: J9 3 700 x} T (`' J Al S (Z-o A <br /> Street <br /> LOC KF_FO(2D CIli 95.23 ,$ 410 J0ACLU) r/ <br /> City State Zip County <br /> 9. Mailing Address: "P <br /> 0 . 6 D k 2 6 p o (See instructions) <br /> Street <br /> LObI CA 95,2g / <br /> City State Zip <br /> 10. Site Contact Person: <br /> D A V I D K o/ JV Z N (See instructions) <br /> First Name Last Name <br /> Contact Person Address: ) 2 3 0 S . G R / 12.. M O /V 7- A V <br /> StreetL� I GA 9S'2'f O <br /> City State Zip <br /> Contact Person Phone Number: Lob 7;2_7 - ,' 70 D Fax Number: (209) 72 7 - 3 SZ 6 <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address: <br /> Preferred Primary Communication: D4 Mail [] Email <br /> D (See instructions.) <br /> 11. Legal Business Owner(not property owner): HE L-1 <br /> � 1��. <br /> Name <br /> Owner Address: P. O• I> 0 k 2 68 a Lob GA- 9 S,2If 0 <br /> Street City State Zip <br /> Owner Phone Number: (9—ot 3 3 Y-ZD S <br /> Area Code Phone Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: 3 2 I (4-Digit Number) (See instructions) <br /> DTSC 1358 10/03 <br />