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f <br /> l <br /> State of California — California Environmental Protection Agency Department of Toxic Substances Control <br /> Office of Environmental Information Management <br /> PERMANENT STATE ID NUMBER APPLICATION e <br /> , <br /> Please type or print legibly in ink. i <br /> NEW NUMBER REQUESTS Check all that apply. E <br /> 0 1 . 1 am applying for a new permanent California 1D 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 269 . 5 <br /> subparts (c) and (d) per month, please complete Form 870042 for a federal EPA ID number. t <br /> c <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER <br /> For existing ID number: C A L 0 0 0 2 9 9 4 1 4 <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. Reason (please select one) : A. ❑ Verification Questionnaire B. ❑ Other <br /> ❑ 5. I am changing the business name only, no ownership change. <br /> i <br /> 5 <br /> i <br /> 6 . Site/Facility/Business Name ( Include DBA): Chrisp Company <br /> 7 . site Location: 1001 Stokes Ave . E <br /> Stoscon California 952154023 San Joaquine <br /> City State Zip Code County <br /> 8. (a) Federal Employer ID Number (b ) Board of Equalization Fee Account Number 22942072 t <br /> ((b) is only required from generators of greater than 5 tons per calendar year.) i <br /> 2 <br /> q <br /> i <br /> 9 . Mailing Address: 1001 Stokes Ave . <br /> S o6kton California 952154023 <br /> city State Zip Code <br /> 10 , Site Contact Person : Jake Chrisp s <br /> First Name Last Name F <br /> Contact Person Address : 1001 Stokes Ave. <br /> Street <br /> Stockton California 952154023 <br /> e <br /> City State Zip Code t <br /> a <br /> Contact Person Phone Number: 2( 09 ) 948-2187 Fax Number: ( 209 ) 948-2179 <br /> Area Code Phone Number Area Code Fax Number <br /> Contact Person Business Email Address : Jchrisp@chrispco.com <br /> a <br /> s <br /> 11 . Legal Business Owner (not property owner): <br /> Robert Chrisp <br /> 43650 Osgood Road , Fremont, California , 94539 <br /> Owner Address : g 3 <br /> i <br /> Sireetl0 933-3914 City 510 st�V0-2703 ZipGode t <br /> Owner Phone Number: 5( Fax Number: ( ) <br /> Area Code Phone Number Area Code Fax Number <br /> 12. Standard Industrial Classification (SIC) Code for the Site: 1 6 1 1 4-Digit Number) <br /> a <br /> r <br /> 13 . Certification: f certify under penalty of law that the Information on this document was prepared to the best of my knowledge and s <br /> belief to be true, accurate and complete. <br /> SIGNATURE handwritten Date 09/25/2019 i <br /> Name (print) William Buckman Title Safety Director Phone (408) 334-0921 <br /> l <br /> DTSC Form 1358 (09/18) s <br /> Page 3 of 3 <br />