COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

State of California California Environr,._-.gal Protection Agency Department of Toxic Substances Control-GISS } P.O.Box 806,Sacramento,CA 95812-0806 CALIFORNIA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION Please type or neatly print in ink. Please review the line-by-line instructions carefully. To check on the status of your request,go to www,hwts.dtsc.ca.gov and click on Reports NEW NUMBER REQUESTS Check all that apply. (See instructions.) ❑ 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator E]Transporter Reason for new number: A. ❑ Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed if your business generates greater than 100 kg of RCRA hazardous waste per month, contact US EPA for a federal ID number. — CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) For existing ID number. C A L � {j 4- G/ ❑ 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. 1 am changing the business name only, no ownership change. 6. Site/Facility/Business Name(Include DBA): M0 'rIs fVQ.U'.S jC1 0( Cur 0 C.o} ��i MUi'1t�p.Cc (lee instructions.)'- d 7. Site Location: _ � ` us�rr m M). Uil(?h n Street maNeca CA q>,,. eco Snnu i n City State Zip County 8. (a)Federal Employer ID Numbercl-111'011(.0 �_ Board of Equalization Fee Account Number P- 0 � p is Only required from f generators ogreater than 5 tons per calendar year.) 9. Mailing Address: i - 0 [. x 1CjSx (See instructions.) Street , A (-'A L - - Cit State _.._....—_..---..._. — Zip 10. Site Contact Person: I f 0yorel ISoY1.)1Q(.�(� (See instructions.) First Name{� t_ast Name ` Contact Person Address: P.0 r;01 1"15,13 1513 Street mon aLi (A 9 C)'3'3 City State Zip Contact Person Phone Number: (c�1r�) r�. {-35C>U Fax Number: (�.( )..2_* -550 Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: Preferred Primary Communication:❑Mail ❑Email 11. Legal Business Owner(not property owner): "off l) H U N M OJ 1 Ca (See instructions.) jme 5 1L {Owner Address: J1 )mannoh C' n Street — City State Zip Owner Phone Number: (_) Fax Number: ( }_ Area Code Phone Number — Area Code Fax Number 12. Standard Industrial Classification(SIC)Code for the Site_ — _ (4_Digit Number) (See instructions. 13. Certification: 1 certify and penalty of law the the information on this document was prepared to the best of my knowledge and belief to be, b e,accurate n n k te. SIGNATURE � —DATE,—,. 2 . "`(`� NAME(print) huV\jw1 Sq)"MgC. ( > c TITLE ;1 p)) ()V17') PHONE {��G i) �. 5cu Na1'kiccr DTSC Form 1358 £0012 IQI,Lallag VDHINVR LT9£6VZ60Z XVd T£:60 OTOZ/ZO/60