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��� -D Ibmit by Email Print Form <br /> ,v1 � et CalNarMa-California Envmnmeo. :oteclion Agency <br /> 7/1{'7`1' fit �]1 P.O.Box 806,S <br /> � scramenw,CA 95812-0808 <br /> 1 2V�7 <br /> pGG 1 N�p�j�FALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br /> Please type or neatly punt in Ink Please review the line-by-line instructions orefulty. <br /> To check on the status of request, o to and click on Reports.I R RE UE TS Check all that apply. (See instructions.) <br /> eL� �1. 1 am applying for a naw permanent California ID number as a hazardous waste: O Generator 11 Transporter <br /> Reason for new number. A. ❑ Never had a number 6 JT Business moved C. ❑ Legal owner of business changed <br /> If your business genarafes greater than 100 kg of RCRA hazardous wasfe per month,conted US EPA for a federal ID number <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING 10 NUMBER p (See instructions) <br /> For existing ID number. C A S -U- G Q Z -L � 7 O a <br /> ❑ 2. 1 am updating the mailing address and/or contact information only. <br /> ❑ 3. I am inactivating this ID Number. <br /> or 4. 1 am reactivating this ID Number. <br /> ❑ 5. 1 am changing the business name only,no ownership change. <br /> (See instructions.) <br /> S. SftafFacility/Business Name(Include DBA): D d H AUTO TECH <br /> 7. Site Location: 720 E HAMMER LN STE MW X-/4V <br /> Street <br /> STOCKTON CA 95210 SAN JOAQUIN <br /> City Slate Zip County <br /> 8.(a)Federal Employer ID Number (b)Board of Equalization Fee Account Number <br /> ((b)is only requaed from generators o/greeter than 5 tons per calendar year) <br /> (See instructions.) <br /> 9. Halling Address: 720E HAMMER LN STE 7ei.1J-/0 <br /> Sbest <br /> STOCKTON CA 95210 <br /> City stere ZIP <br /> (See b18tructio la) <br /> 10. Site Contact Person: DENNY NGUYEN <br /> First Name Leet Name <br /> C~Person Address: 720 E HAMMER LN STE 100 <br /> Street <br /> STOCKTON CA 95210 <br /> city state ZIP <br /> Contact Person Phone Number: (x'.951-1100 Fax Number. (� <br /> Area Coda Phone Number Area Code Fax Number <br /> Contect Person Business Email Add :NGUYENDENNYHSBCGLOBAL.NET Preferred Primary Communication: in Mail a Emae <br /> (See instructions.) <br /> 11. Legal Business Owner(not property owner): LUCY NGUYEN <br /> Name <br /> Owner Address: 5624 CARNELIAN DR STOCKTON CA 95210 <br /> Sheat City state Zip <br /> Owner Phone Number (209 951-1100 Fax Number. (� <br /> Area Code Phare Number Area Code Fax Number <br /> 12. Standard Industrisi Classification(SIC)Code for the Site: _ (4-D It Number) (Sea Instruction) <br /> 13. Certificabon: I ow*under penally oflaw that the information on this document was prepared to Ole best of my knowledge and <br /> befieflo be,hue,accureleand complete. r <br /> SIGNATURE DATE O <br /> NAME(print) �e / /U TfTL r PHONE9t5-') -Ili d <br /> r� <br /> OTSC Form 1358(MM <br />