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State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> Office of Environmental Information Management <br /> PERMANENT STATE ID NUMBER APPLICATION <br /> Please type or print legibly in ink. <br /> NEW NUMBER REQUESTS Check all that apply. <br /> ❑ 1. 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑Transporter <br /> Reason for a new number: A. ❑ Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed <br /> If your business generates greater than 100 kg of RCRA hazardous waste other than those hazardous waste listed in 40 CFR 261.5 <br /> subparts(c)and(d)per month,please complete Form 8700-12 for a federal EPA ID number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER <br /> For existing ID number: C A L 0 0 0 4 1 3 1 0 1 <br /> 112. 1 am updating the mailing address and/or contact information only. <br /> ❑ 3. 1 am inactivating this ID.number. <br /> KI 4. 1 am reactivating this ID number. Reason(please select one): A. ❑ Verification Questionnaire B. ❑ Other <br /> ❑ 5. 1 am changing the business name only, no ownership change. <br /> 6. Site/Facility/Business Name(Include DBA): Pearl Crop Inc <br /> 7. Site Location: 1550 Industiral DR <br /> Stditn CA 95206 San Joaquin <br /> City State Zip Code County <br /> 8. (a)Federal Employer ID Number27-1834327 (b)CDTFA Account Number <br /> ((b)is only required from generators of greater than 5 tons per calendar year.) <br /> 9. Mailing Address: 1550 Industrial Dr <br /> .906kton CA 95206 <br /> City State Zip Code <br /> 10. Site Contact Person: Marcelino Martinez <br /> First Name Last Name <br /> Contact Person Address: 1550 Industrial Dr <br /> Stockton CA 95206 <br /> City State Zip Code <br /> Contact Person Phone Number: (209 ) 808-7575 Fax Number: 2( 09 ) 254-9859 <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address:marcelino.martinez@pearicrop.com <br /> 11. Legal Business Owner(not property owner): Ulash Turkhan <br /> Owner Address: 1550 Industrial Dr Name Stockton CA 95206 <br /> St (e 09 808-7575 City 209 'N4-9859 Zip Code <br /> Owner Phone Number:: ( ) Fax Number: ( ) <br /> Area Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Classification(SIC)Code for the Site: 2 0 6 8 (4-Digit Number) <br /> 13. Certification:I certify under penalty of law that the ' rmation on this document was prepared to the best of my knowledge and <br /> belief to be true, accurate and complet <br /> SIGNATURE(handwritten) Date ® .2 2� <br /> Name(print) _I,IIAIg k `M l Title t' � Phone �$ 5? <br /> DTSC Form 1358(06/19) <br /> Page 3 of 3 <br />