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Jul. 16. 2010 6: 53AM Gold-n State Irrigation No. 0351 P. 2 Slate of Celltornla-California Environmental ProteCtlan Agency Department of TOxle Subslances Control-GISS ...ti i Gt P.O.Box 808,Sacramento,CA 958120806 :.IBJ) CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or neatly print In ink. Please ra*w the line-by-line Instructions carefully. To check on the status of your reueat,go to ov and dick on Reports. NEW NUMBER REQUESTS Check all that apply. (Sao Instructions.) 1. 1 em applying for a new permanent California ID number as a hazardous waste: p Generator Transporter Reason for new number. A ❑ Never had a number B. 1-1 Business moved C. []Legal owner of business changed If your business generatesgreater7han 100 ky ofRCRA hazardous waste per month,contact US EPA fora federal ID number. CHANGES TO STATUS OR INFORMATIONFOR AN EXISTING ID NUMBER (See Instructions.) For existing ID number. C A L' 2. 1 am updating the mailing address and/or contact Information only. 3. 1 am inactivating this ID Number. �(4, 1 am reactivating this ID Number. ❑ 5, lam changing the business name only,no ownership change. (See instructions_) S. Site/Facility/Buslness Name(Include DBA): G��Ot N �TnTE lux(�TuL l SE u7�l 7. Site Location: ll(.04 3 14, S lkbkeJ [L A-O Street 5iur.t&mt l C A- qI-xff SM.L �y utt.l City , - Board of Equalization Fee Account Number /P '111 U-jai I 33 (b)Is only required from generators of greater than 5 tons per calendar year.) `� '�1 •r (See Inahuctions.) 8. Mailing Address: Y.0 t'oi 300 kU Srpchid[ Th" CA l�Sa13 City • Slate Zip 10. Site Contact Person: Sco-tr ST-LVA (See instructions.) FirrrPk s�t Name an Last Name Contact Person Address: l ^AQ Ph fto nV E Street city ^►^1�7 1/State ZIP 'I Contact Person Phone Number: (.26q) qq 3-" 'f T T`I Fax Number (�_*, q4 3- U��t Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: Preferred Primary Communication:MMall ©Email (See instructions.)11. Legal Business Owner(not property ownar): \w/�l,�f T"Ot&^(L r T / Owner Address: ToolN, as-41 �NTma \/N.*,4 WF bt6w Sires S� 3 Cily State Z Owner Phone Number. ( `w2) q—')�0 Fex Number: (�)j 3 S1--u 14JR Area Code Phone Number ^ Area Code Fax Number 12. Standard Industrial Classification(SIC)Code for the Site: 3 d (4-Digit Number) ee Instructions.) 13. Certification: I cartifyr�ypnder penalty of low that the Information on this document was prepared to the best of my knowledge and belief to be,true,a 4rrate nd comp le. y SIGNATURE Co ATE 1 �( Ire NAME(print) kErjr SUVA TITLE GMPHONE(,)In) aq3 7y DTSC Form 1358(5/99)