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State of California California Enviromental Protection Agency Department of Toxic Subsrances Control <br /> P.O.Box 806 <br /> Sacrarne]ILQ,CA 95s 12-0806 <br /> California Hazardous Waste permanent ID Number Application <br /> Please review the line y-line instructions carefzilly and complete rill items on the application. l <br /> New Number Requests. Check all that apply. (Sue instructions.) <br /> [) 1. 1 am applying for a new perman nt CaliforniH i1-1 number as a, Generator Tran3portcr <br /> Reason for new number: A. M Never had a number S. [] 81 siness moved C. W Legal owner of business changed <br /> Cha Status or Information, (See instructions) <br /> For ID number= C A <br /> [] 2. I am ureis,ting 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 /> 1 am changing the business rrurrit:. 'here has been no ownership change. <br /> 6. This site is a: Conditionally �xempt Small Quantity Generatnr of RCRA waste (See ir:.Yt,zrutvas,) <br /> Generator of less than 1,000 kg/month California-only waste ' <br /> [] Generator of greater than 1,000 kg/month California-only waste <br /> 7. Site/Facility Name: <br /> 8. Site Location: W , l � <br /> Street <br /> n `tt �l <br /> City State Zip County <br /> 9. Mailing Address: Ft v—t� <br /> (See instructions.) <br /> Street <br /> City State Zip <br /> 10. Site Contact Person: q (See instructions.) <br /> First Name last Name <br /> Contact Person Address: 3sD (n y k <br /> Street <br /> City State Zip <br /> q2 ) rlr!– /5,6I <br /> Contact Person Phone Number_ !�,3.�– J )a Fax Number: <br /> Area Code PhoneNumber Area Code Fax Number <br /> Contact Person Business Email Address: <br /> Preferred Primary Com mUnieation: Mail [) Ernail <br /> 11. Legal Business Owner(not property wncr):_—M PWe$.'- - Pit TEL (See instructions.) <br /> Namc <br /> Owncr Address: l a,7_ , I <br /> Street! Ciry State Zip <br /> Owner Phone Number: <br /> Area Code Phone Number <br /> ?. Standard Industrial Classification(SI ) Code for the Site: (4-Digit Number) (see instructions) <br /> DTSC 1358 10103 <br /> I <br /> ZO 39dd 3Ad3SAIMA Z9KH860Z VZ :ZO bOOZ/9Z/OZ <br />