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State of California—Calffomiz Environmental Protection Agency Department of Toxic Substances Control Office of Environmental Information Management Permanent State ID Number Instructions and Application (DTSC Form 1358) Do nod use DTSC Form f358 b applyfloratempors, State ID numberor to RP p or make then as to a federal EPA ID number. 1 New Number . Ifyou are applying for a new permanent State ID number,check this box.Select Generator, Requests Transporter or both,and select the reason you are applying. . You cannot apply for a new permanent State ID number and the Inactivation of an existing permanent State ID number on the same application.Two separate applications must be submitted. 2-5 Changes to Status or . Check the a ppropriate box to update,Inactivate or reactivate a permanent State ID number or to Information for an change the business name only. Existing State ED . Apermanent 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 ED number. . You may change the business name without applying for a new permanent State l D number if there has been no change in ownership. a Site/Facility/Business . Enter the legal name of the she/facility/business,this may include a Doing Business As(DBA). Name 7 Site Location . 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. Be— Federal Employer . Enter the Federal Employer ID Number(FEIN),also known as the Federal Tax Identification Number. Bb ID Number/ If the business is a sole proprietorship and does not have FEIN,enter"sole Proprietorship"or California "N/A".This field is required and cannot be left blank. Department of Tax . ACDTFA 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 Meiling Address Enter the mailing address.This address may be different from the site location address. 10 Site Contact . Enter the site contactperson's name,address,and phone number. Information Entering an email address a nd fax number are recommended if available. 11 Legal Business . Enter the legal business owner's Information.Ifthe 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 num bar. 12 Standard industrial . Enter your 9-digit Standard Industrial Classification(SIC)Code.The SIC Code best describes your Classification(SIC) companys primary business activity.To search for your SIC Code please visit Code for the Site httos://www.osha.gov/ols/imis/sicsearch.htmi. 13 Certification . 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. Postal Mall Email Fax Department of Toxic Substances Control idnumberfddtscca.go, (916)323-3500 DEEM—Business Operations Unit,11th Floor P.O.Box 906 An email submission is recommended for DTSC does not confirm receipt offaxes. Sacramento,CA 95812-0806 traceability. DTSC does not confirm receipt of mail. Instructions for DTSC Form 1358(6/19) Page 1 of 3