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California Environmental Protection Agency <br /> Permanent State ID Number Application Department of Toxic Substances Control <br /> DTSC Form 1358 (Revision 05120) Page 1 of 2 <br /> NEW NUMBER REQUESTS. Check all that apply <br /> ❑ 1. 1 am applying for a new permanent State ID number as a hazardous waste; <br /> Z a) Generator ❑ b) Transporter <br /> Reason for a new number: <br /> ❑ a) Never had a number ❑ b) Business moved ❑ c) Legal business owner changed <br /> If your business generates greater than 100 kg of RCRA hazardous waste other than those <br /> hazardous wastes listed in 40 CFR 261.5subparts (c) and (d) per month, complete the EPA <br /> Form 870012 for a federal EPA ID number. <br /> CHANGES TO STATUS OR INFORMATION FOR AN EXISTING STATE ID NUMBER <br /> For existing ID number(Include the lettered prefix): <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): Stockton Tri Industries, LLC <br /> 7. Site Location: 2141 F. Anderson Street <br /> Street _. <br /> Stockton CA 96206 San Joaquin <br /> City State ZIP Code County <br /> 8. a) Federal Employer ID Number: 83-3868213 <br /> b) CDTFA Account Number: 215021824-00001 <br /> This is only required from generators of greater than 5 tons per calendar year. <br /> 9. Mailing Address: PO Box 6097 <br /> Street <br /> Stockton CA 95206 <br /> City - State - ZIP Code <br />