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M.. <br />State of California – California Environmental Protection Agency"` Department of Toxic Substances Control <br />P.O. Box 806 <br />Sacramento, CA 95812-0806 <br />California Hazardous Waste Permanent ID Number Applic ilslm <br />Please review the line -by-line instructions carefully and complete all item��s on the application. ion.T �� 9� 20 <br />ak <br />N w Number Reguests. Check all that apply. _ fl` Vi'i tr�siii'�Iibhi. L r Y <br />1. I am applying for a new permanent California ID number as a: [ ] Generator (] Transporter <br />Reason for new number: A. [ ] Never had a number R. [ ] Business moved C.X Legal owner of business changed <br />Changes to Status or Information. (See instructions.) <br />For ID number: C A— <br />[) 2. I am updating the mailing address and/or contact information only. <br />[) 3. 1 am inactivating this ID Number. <br />[) 4. 1 am reactivating this ID Number. <br />[ ] 5. I am changing the business name. There has been no ownership change. <br />6. This site is a: [ ] Conditionally Exempt Small Quantity Generator of RCRA Waste (See instructions) <br />[ ] Generator of less than 1,000 kg/month California -only waste <br />(J Generator of greater than 1,000 kg/month California -only waste <br />7. Site/Facility Name: l oW r Sct(.1 D412/1 to C Ntcur"All <br />r <br />8. Site Location: "bo %ZJ <br />Street <br />c�ti L� YSZta <br />Srock <br />City State Zip County <br />(See instructions.). <br />9. Mailing Address:b <br />Street Ca <br />Sb GK. f &t. <br />r;tV State Zip <br />(See instructions) <br />10. Site Contact Person: UW1_V lrt/tt <br />First Name Last Nanfe <br />Contact Person Address: b b 0 wt/ $Qu^tzvrl_d r+1ty"� <br />Street <br />C_ A- ct S21a <br />City State Zip <br />Contact Person Phone Number: (Z t-1 2 % t'+ Fax Number: ( i) XArea Code Fax Number <br />Area Code Phone Number Are <br />Contact Person Business Email Address: <br />Preferred Primary Communication: Mail [ ] Email <br />_ (See instructions) <br />11. Legal Business Owner (not property owner): '�t l V Q., e t <br />Name,2 <br />Owner Address: b �V wy Sr Gri Qi �'y �� �� State Lr^ <br />s (a <br />city i State Zip <br />Owner Phone Number: <br />Area Code Phone Number <br />12. Standard Industrial Classification <br />DTSC 1358 10/03 <br />i1C) Code for the Site: _ — (4-01git [ <br />-�e� w► -� CTO 2,5T- <br />43 03 <br />