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State of California - California Environmental Protection Agency Department of Toxic Substances Control - GISS <br />DEC 4 2008 <br />P.O. Box 806, Sacramento, CA 95812-0806 <br />2es�tForm:- = Pi!'�r'>!'t <br />CALIFORNIA H RD WASTE PERMANENT ID NUMBER APPLICATION <br />Please type or nest[ r t1 a Bne-by-line instructions carefully. <br />To check on the status of your request, go to c v and click on Reports. <br />NEW NUMBER REQUEST$ Check all that apply. (See Instructions.) <br />® 1. 1 am applying for a new permanent California ID number as a hazardous waste: a 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 greater than 900 kg of RCRA hazardous waste per month, contact US EPA for a federal ID number. <br />CHANGES TO STATUS OR INFORMATION FOR AN EXISTING ID NUMBER (See instructions.) <br />For existing ID number: C A <br />® 2. 1 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. 1 am changing the business name only, no ownership change. <br />6. Site/Facility/Business Name (Include DBA): N. J. McCutchen, Inc. <br />7. Site Location: 345 S. Madison, St. <br />(See instructions.) <br />Street CA 95203 San Joaquin <br />Stockton <br />City state Zip County <br />8. (a) Federal Employer ID Number 94-2378167 Board of Equalization Fee Account Number <br />(m) is only required from generators of greater than 5 tons per calendar year.) <br />9., Mailing Address: <br />123 W. Sonora St. (See Instructions.) <br />Street <br />Stockton CA 95203 <br />city state Zip <br />10. Site Contact Person: <br />Alan McCutchen (See instructions.) <br />First Name Last Name <br />Contact Person Address: 123 W. Sonora St. <br />Street <br />Stockton CA 95203 <br />City State zip <br />Contact Person Phone Number:2( 09) 466-9704 Fax Number: ( 209) 466-2874 <br />Area Code Phone Number Area Code Fax Number <br />Contact Person Business Email Address: alae@njminc.com Preferred Primary Communication: ®Mall ❑ Email <br />11. Legal Business Owner (not property owner): <br />N. J. McCutchen, Inc. (See instructions.) <br />Name <br />owner Address: 123 W. Sonora St. Stockton CA 95203 <br />Street city state Zip <br />Owner Phone Number:2( 09 } 466-9704 Fax Number:2( 09 } 466-2874 <br />Area Code Phone Number Area Code Fax Number <br />12. Standard Industrial Classification (SIC) Code for the Site: 3 4 4 3 (4 -Digit Number) (See instructions.) <br />13. Certification: I certify under penalty of law that the Information on this document was prepared to the best of my knowledge and <br />belief to be, true, accurate and complete. <br />SIGNATURE A DATE 13 D w j2 r zo 0 8 <br />NAME (print) AI 0 h M G C,v,-�z.Lt tl-} TITLE �,[ : P . PHONE W9 4-6 (o g10 <br />