My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_PRE 2019
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
D
>
DR MARTIN LUTHER KING JR
>
749
>
2200 - Hazardous Waste Program
>
PR0523154
>
COMPLIANCE INFO_PRE 2019
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
4/28/2020 5:03:57 PM
Creation date
4/28/2020 4:27:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0523154
PE
2220
FACILITY_ID
FA0003870
FACILITY_NAME
SRH FOOD & GAS
STREET_NUMBER
749
Direction
E
STREET_NAME
DR MARTIN LUTHER KING JR
STREET_TYPE
BLVD
City
STOCKTON
Zip
95206
APN
14734309
CURRENT_STATUS
01
SITE_LOCATION
749 E DR MARTIN LUTHER KING JR BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\dsedra
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
76
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
State cf California—Californiavironmental Protection Agency Department of Toxic Substances Control-GISS Print <br /> Reset Form P.O.Box 806,Sacramento,CA 95812-0806 <br /> CALIFOR;check <br /> IA HAZARDOUS WASTE PERMANENT ID NUMBER APPLICATION <br /> Please type or neatly print in ink. Please review the line-by-line instructions carefully. <br /> on the status of your request,go to www.hwts.dtsc.ca. ov and click on Reports. <br /> NEW NUMBER RE UEST Check all that apply. (See instructions.) <br /> 1. I am applying for a n permanent California ID number as a hazardous waste:}Generator ❑Transporter <br /> Reason for new number A. ❑ Never had a number B. ❑ Business moved C. Legal owner of business changed <br /> If your business generates g eater than 100 kg of RCRA hazardous waste per month, contact US EPA for a federal ID number. <br /> CHANGES TO STATUS ORI INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) <br /> For existing ID number: A <br /> ❑ 2. 1 am updating the mai ing address and/or contact information only. <br /> ❑ 3. 1 am inactivating this I Number. <br /> ❑ 4. 1 am reactivating this I Number. <br /> ❑ 5. 1 am changing the bu iness name only, no ownership change. <br /> �� (See instructions.) <br /> 6. Site/Facility/Business Na a(Include DBA): <br /> 7. Site Location: <br /> Stre t <br /> L <br /> ity State Zip County <br /> 8. (a)Federal Employer IDNumber Board of Equalization Fee Account Number <br /> ((b)is only required from generators of greater than 5 tons per calendar year.) <br /> ` (See instructions.) <br /> 9. Mailing Address: C - W. <br /> Street <br /> o de-To <br /> City State Zip <br /> I A (See instructions.) <br /> 10. Site Contact Person: mom'�Il VJ <br /> First Name <br /> aName Las Name <br /> Contact Person Address: Ll - 991` <br /> Strdet <br /> M:iC '� <br /> i State Zip <br /> Contact Person Phone Nt mber:.(1 71`, �� W Fax Number: (_) <br /> Area ode Phone Number Area Code Fax Number <br /> Contact Person Business Email Address: e( Xo COtteferred Primary Communication: Mail ❑Email <br /> (See instructions.) <br /> 11. Legal Business Owner(n)t property owner): 114 U haw-VI r-1G'cL� �1 Z ��'���`� <br /> � q T E Name- T��� C <br /> Owner Address: /�L .6-C S <br /> Stre tCity State Zip <br /> Owner Phone Number: _c -21• a 7?3 Fax Number: (_) <br /> rea Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Clas fication(SIC)Code for the Site: (4-Digit Number) (See instructions.) <br /> 13. Certification: I certify unc er penalty of law that the information on this document was prepared to the best of my knowledge and <br /> belief to be, true,accurat and complete. <br /> SIGNATURE <br /> DATE <br /> NAME(print) 1 1�� �V�^ ITLE /'79/6 1 i PHONE �.! '• �f [�S o l�� <br /> DTSC Form 1358(6/08) <br />
The URL can be used to link to this page
Your browser does not support the video tag.