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22525 South Airport Way PR0539882 <br /> June 3, 2019 Program: HW <br /> PHOTO 7: Application for ID number reactivation filled out on site and emailed. Lydia Baker (REHS) was cc'd on email. <br /> 7 \�2 E'-- Ofece or enHromm�mnl Inrom nun Mnnnamm�nt <br /> a E s tUMBISR APPLICATION <br /> In aPPI I Check elle that Ibl In In <br /> Reason fory ng for a new permanent C <br /> ,pub rrr tiusinessa new number. A, C"I Na Itardous waSIGyWGenerstor I 1 Transporter <br /> _Darts(o), 9anen3tes greeter then 100 lioness moved C. ❑ Legal owner of business chnnyexi <br /> d Via)Per month,please cord Ne other Men those hnzardnus waste Iistud in JO(Y A'?R I S <br /> !V H IES TO -- Ifaral EPA ID nunvber <br /> 1-or �-STASIS F _ <br /> exlt;tin y_,QRIyI <br /> 9 ID II <br /> number: C A TAT ON I EFLID NI <br /> _ <br /> 2. I am updatin S� (� <br /> p 3 l 9 the mailing address and/or contact information only. <br /> r� am inactivating this ID number. <br /> j1 I am reactivating this ID number. Reason(please select one): A. Cl Vsdflutlon Questionnaire Ir I nw.n <br /> (Q5. 11 am ch Ing ng tlhe business name only,no ownlnhip change. <br /> B. Site/(Facility/Business Name(Include DBA)' <br /> i' Site(Location: <br /> .ire <br /> fl. a Federal Em City ID Number State <br /> O 9��� p a Conimy — <br /> 11t9 1L,u_(b)Board of Equalization Fee Account Number <br /> b I3 d411y roqulred Iron r<lnnerreatnr.c nl l;r r,;rfnr lh;In',to',p", „hrrn t rr <br /> g. Mailing Address: <br /> £trest <br /> City -- at) <br /> 10. Site Contact Person: <br /> First Name L Leet eme <br /> Contact Person Address: LXf <br /> TA <br /> City �c.� state �y� Ip Code <br /> Contact Peri bar: (, �)_ n n_ _Fair Number'. (�.JI) <br /> Area Code _tsnone Number Area Gode Fax Number <br /> mailAddr <br /> nyrnvnerl:_ <br /> t!r•�1---�----=IJU.iV�— <br /> :. r.uy .rd. npn..dn <br /> I us Nun.L•., ! I <br /> Phone Number r,,.,.. .,n. ii....a.,. <br /> non.Nnnn..... <br /> Bhnn ul,Ihr.,b...uuuut w. Iv.q,nm l L Il r.,Lu.l ul u.l Lnnnlu.Ali,,ran i <br /> 1711e ��l <br /> i"ct r `� <br /> Lydia Baker, REHS Page 7 of 7 <br />