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State of Califorria-California Environmental Protection Agency Department of Toxic Substances Control <br /> Transportation Unit <br /> 8966 Cal Center Dri.e,Sacramento CA 95826 <br /> Phone(916)440-7145 Fax(916)255-6436 <br /> HAZARDOUS WASTE TRANSPORTER REGISTRATION APPLICATION <br /> 1. Name of Legal Entity(Individuai,Partnership,Corporation,or Limited Liability Company): 2. Transporter Registration Number <br /> (If-erewal or reinsatement) <br /> Environmental&Chemical Consulting, Inc. 6 2 2 5 <br /> 3 Business Name,Show d.b a.name,show name exactly as it will appear on registration;same name or 4.Application Type(check one) <br /> trademark s required on all vehiciesl: a New N Reinstatement <br /> ]� Renewal : Midyear Amendment <br /> 5.Business Address NumberlStreet City CountyfProvince StatelCountry ZiplPostal Code <br /> 1500 Crafton Avenue; Bldg. 129 Mentone San Bernardino CA 92359 <br /> E Mailing Address(I(different)P.C.BoxiStreez City Cou ntylProvinoe StatelCountry Zip/Postal Code <br /> PO Box 3263 Crestline San Bernardino CA 92325 <br /> 17a.Telct <br /> Telephone Number (Ext.Number) 8. Transporter identMcation Number. List ail of the 12-cheraer identlfrcetion numbers that your business <br /> 1909 l 1 714-20-95 uses to transport hazardous waste. If necessary, list adcitional identification numbers on a separate <br /> sheet. <br /> 7b.Fax Number <br /> CAR000241448 <br /> 7c.E-mail Address <br /> david@eccinc.us <br /> 9. Other Business Addressies)-List ail locations from which you will operate under this registration: <br /> (If necessary,list adcitional business adcresses on a separate sheet.) <br /> NumberlStreet City Countylprovinoe SUWCountry Zi rPostal Code <br /> 9436 W. Sugar Road Tracy San Joaquin CA 95304 <br /> 0.Ownership of Business(Check one): <br /> Sole Proprietorship V Partnership [Corporation V Limited Liability Company d Other <br /> If a Sole Proprietorship or Partnersh p, ist namels)or tide(s)of all members.tl you have no California locations,inclt,de an Agert For Service of Process- <br /> If a Corporation or_imited Liability Company.lis:name(s;and title(s)of officers including Agent for Servloe of Process. <br /> Name Title <br /> David T. Rains President <br /> Name and Address of Agent for Service of Process: <br /> David Rain5- 21936 Mn-jave r 92322 <br /> Note: Transportation of hazardous waste without proper registration and public liability insurance is a violation of the <br /> Health and Safety Code, Sections 25163 and 25169,and may subject you to significant penalties. <br /> 11. I undersand and will comply with all the applicable hazardous waste transportation requirements inducng Chapter 6.5, Division 20, of the California <br /> Health and Safety Code; Chapter 13, Division 4.5. d e 22, California Coce of Regulations; and federal 'aws and regulations governing the use of <br /> manifests. I cet,fy under penalty of pe-jury to the accuracy of all statements made herein. <br /> Vane and Title o rth Repro ntati prim.or type; Wade Ridderintr, Regulatory Compliance <br /> 9,'l 512019 <br /> Siralure of Authorized Repress ive Use blue or other non-black ink. Tarte <br /> DO NOT WRITE BELOW THIS LINE FOR DTSC USE ONLY) <br /> E-TSC 187 739 <br />