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RECEIVED BY SJCEHD (EF) on 4/20/2020 State of California— California Environmental Protection Agency Department of Toxic Substances Control Office of Environmental Information Management Permanent State ID Number Instructions and Application (DTSC Form 1358) Do not use DTSC Form 1358 to apply for a temporary State ID number or to apply or make changes to a federal EPA ID number. Item # Section Email 1 New Number • If you are applying for a new permanent State ID number, check this box. Select Generator, (916) 323-3500 Requests Transporter or both, and select the reason you are applying. P.O. Box 806 • You cannot apply for a new permanent State ID number and the inactivation of an existing DTSC does not,confirm receipt of faxes. Sacramento, CA 95812-0806 permanent State ID number on the same application. Two separate applications must be submitted. 2-5 Changes to Status or a Check the appropriate box to update, inactivate or reactivate a permanent State ID number or to �� kms.•', Information for an change the business name only. Existing State ID a A permanent State ID number is specific to the location and owner to which it was assigned. If your Number business has moved or had a change in ownership, you must apply for a new permanent State ID number. • You may change the business name without applying for a new permanent State ID number if there has been no change in ownership. 6 Site/Facility/Business • Enter the legal name of the site/facility/business, this may include a Doing Business As (DBA). Name 7 Site Location a Enter the site/business location address, including the name of the county. • A permanent State ID number is specific to the location and owner to which it was assigned. If your business has moved or had a change in ownership, you must apply for a new permanent State ID number. • The address must be a physical address; street number and street name. If there is no physical address, latitude and longitude or assessor's parcel number is acceptable. • Post office boxes or descriptive addresses are not acceptable. 8a — Federal Employer • Enter the Federal Employer ID Number (FEIN), also known as the Federal Tax Identification Number. 8b ID Number/ If the business is a sole proprietorship and does not have a FEIN, enter "sole proprietorship" or California "N/A". This field is required and cannot be left blank. Department of Tax • A CDTFA Number, also known as a Hazardous Waste Generator Fee account number is only required and Fee if your business generates or produces five or more tons of hazardous waste per calendar year, Administration regardless of the final waste disposition. DTSC notifies the California Department of Tax and Fee (CDTFA) Number Administration (CDTFA) when a State ID number has been issued. To apply for a CDTFA Number or for more information, please visit cdtfa.ca.gov. • If the business does not have a CDTFA Number, this field will be blank. 9 Mailing Address • Enter the mailing address. This address may be different from the site location address. 10 Site Contact 0 Enter the site contact person's name, address, and phone number. Information • Entering an email address and fax number are recommended if available. 11 Legal Business • Enter the legal business owner's information. If the business is a corporation, enter the company's Owner legal business name. Example: Mike's Bikes, Inc. • Do not enter the property owner or management company since they are not the entity generating hazardous waste. • DTSC does allow a change in ownership to an immediate family member without issuing a new permanent State ID number. • If there has been a change in ownership, you must apply for a new permanent State ID number. 12 Standard Industrial . Enter your 4 -digit Standard Industrial Classification (SIC) Code. The SIC Code best describes your Classification (SIC) company's primary business activity. To search for your SIC Code please visit Code for the Site https://www.osha.gov/pls/imis/sicsearch.html. 13 Certification a The application must include a hand-written signature of an owner, officer or employee of the business or an authorized consultant. DTSC does not accept digital signatures. • Enter the date, name, title, and phone number of the person who is signing. 4'f � 0 2020 Instructions for DTSC Form 1358 (6/19) ENVIRONMENTAL HEALTH Page 1 of 3 DEPARTMENT Application Submission Postal Mail Email Fax Department of Toxic Substances Control idnumber@dtsc.ca.gov (916) 323-3500 OEIM — Business Operations Unit, 11th Floor P.O. Box 806 An email submission is recommended for DTSC does not,confirm receipt of faxes. Sacramento, CA 95812-0806 trackability. �� kms.•', DTSC does not confirm receipt of mail. 4'f � 0 2020 Instructions for DTSC Form 1358 (6/19) ENVIRONMENTAL HEALTH Page 1 of 3 DEPARTMENT