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State of California — California Environmental Protection Agency Department of Toxic Substances Control Office of Environmental Information Management PERMANENT STATE ID NUMBER APPLICATION Please type or print legibly in ink. NEW NUMBER REQUESTS Check all that apply. ❑ 1 . 1 am applying for a new permanent California ID number as a hazardous waste: ❑ Generator ❑ Transporter Reason for a 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 other than those hazardous waste listed in 40 CFR 261 . 5 subparts (c) and (d) per month, please complete Form 870042 for a federal EPA ID number. CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER For existing ID number: CA L 0 0 0 4 2 5 7 1 4 ❑ 2 . 1 am updating the mailing address and/or contact information only . ❑ 3 . I am inactivating this ID number. EO 4 . 1 am reactivating this ID number. Reason (please select one) : A . ❑ Verification Questionnaire B . ❑ Other ❑ 5 . I am changing the business name only, no ownership change . 6 . Site/Facility/Business Name ( Include DBA) : PETCO # 1291 7 . Site Location : 2350 W. KETTLEMAN LANE # 120 LObfeet CA 95242 SAN JOAQUIN City State Zip Code County 33-0479906 8 . (a) Federal Employer ID Number (b) CDTFA Account Number ( (b) is only required from generators of greater than 5 tons per calendar year.) 9 . Mailing Address : 654 RICHLAND HILLS DR 9ANt ANTO N I O TX 78245 City State Zip Code 10 . Site Contact Person : AMY EBERSOLE-MARTINEZ First Name Last Name Contact Person Address : 654 RICHLAND HILLS DR Street SAN ANTONIO TX 78245 City State Zip Code Contact Person Phone Number: ( 210 ) 201 -9217 Fax Number: ( ) Area Code Phone Number Area Code Fax Number Contact Person Business Email Address: SAFETY@PETCO . COM 11 . Legal Business Owner (not property owner) : P_ENTCO ANIMAL SUPPLIES Owner Address : 654 RICHLAND HILLS DANTONIO , TX 78245 Stree10 201 -9217 City State Zip Code Owner Phone Number: ( ) Fax Number: ( ) Area Code Phone Number Area Code Fax Number 12 . Standard Industrial Classification (SIC ) Code for the Site : 5 9 9 9 (4-Digit Number) 13 . Certification : I certify under penalty of law that the information on this document was prepared to the best of my knowledge and belief to be true, accurate and complete . A ^ Digitally signed by Amy Ebersole-Martinez V v DN: cnAmy Ebersole-Martinez, o, ou, 4 . 20 . 2020 email amy.ebersolemartinez@ , cpetco.comUS SIGNATURE (handwritten ) Date: 2020.04.2010:29:27 -0500' Date Name (print) AMY EBERSOLE- MARTINEZ Title MANAGER , ESH Phone 210-201 -9217 DTSC Form 1358 (06/19) Page 3 of 3