Laserfiche WebLink
State of California — California Environmental Protection Agency Generator Information Services Section <br />Department of Toxic Substances Control 1-877-454-4012 (Calif. Callers Only) <br />P.O. Box 806 or 1-916-324-2996 (Outside Calif.) <br />Sacramento, CA 95812-0806 www.dtsc.ca.gov <br />2000 VERIFICATION ETIOIR <br />(Seeback of this form for instructions.) <br />The Department of Toxic Substances Control (DTSC) requires that the enclosed forms be completed and retumed with <br />appropriate fees not later than 30 days from the date of receipt. Instructions for all forms are included. <br />SUMMIT LOGISTICS INC If your mailing address has changed, please <br />16900 W SCHULTE RD PRINT or TYPE the correct address below: <br />TRACY CA 95376-8985 <br />Address: <br />City/State/Zip: <br />3. COMPANY OWNER INFO: NOTE: Califomia EPA ID numbers issued by DTSC may not be transferred <br />to another owner. If the ownership of your organization has changed, please <br />call GISS for assistance. Do NOT fill in new owner information below. <br />SAFEWAY INC. Company owner name: <br />5918 STONERIDGE MALL ROAD Address: <br />PLEASANTON CA 94588-3229 <br />(510) 891-3000 City/State/Zip: <br />Telephone: <br />Date of ownership change: <br />4. L3 My new EPA ID number is ®_ <br />6. COMPANY NAME: If printed company name is incorrect, please provide correct name: <br />SUMMIT LOGISTICS INC <br />Company name: <br />6. CONTACT INFO: If printed contact is incorrect or blank, please provide correct information: . <br />THOMAS MAGERS/ENGINEERING DIR Name/Title: <br />16900 W SCHULTE RD Address: <br />TRACY CA 95376-0000 <br />(209)833-4936 City/State/Zip: <br />Telephone: <br />7. Standard Industrial Classification (SIC) Code (4 digits)____ <br />8. ❑ Check here if you wish to CANCEL the EPA ID number listed on Line 1. (See reverse side.) <br />9. If the Verification Questionnaire (VQ) were available via the Internet, would you use it? ❑ Yes ❑ No <br />DTSC 1193 [front] (3/00) 7/2 <br />69193 <br />