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-KA •c.,� <br /> � I UVI <br /> State of Califomia-Califomia unvi ,mental Protection Agency <br /> Dcpaitmcnt of Toxic Substances Control <br /> P,O.Box 806 <br /> California azardous Waste Permanent I13 Number Appliicationacrumernto,CA 95312-0306 <br /> Please review ll•�e lin -by-line Instructions carefully Ind complete all items orr tha nppliomaon, <br /> f <br /> ;ery Number Reuuests• Check alI th c apply. <br /> I am applying for a nCrr permau ent California ID number as a: (SFS instre+ctiorrs.) <br /> TransOrtr <br /> Reason for new number: A, Never had a number B. (J Bfisiness moved GeneratorGC. I eg�ticowner of busincs changed <br /> Changes to Status or Information. <br /> For ID number: C A _ (See instructions,) <br /> t] 2- lam updating the—' addres aiu]/ur contact intbtmation only. <br /> (j 3. 1 am inactivating this ID Nu ibe <br /> ] 4, I am reactivating this ID'Number <br /> S. 1 ane changing the bu,incss name, 'I here has been no ownership change. <br /> This site is a: Conditionally xe-pt Small Quantity Gcneramr ofR RA Waste <br /> ] Generator of 1 ss than 1,000 kg/month California-Only waste (See instructions-) <br /> [] Generator of eater thwi 1,000 kg/month California-only waste <br /> Site/Facility Name: l <br /> Site Location: <br /> _Street <br /> City State ;p County r X. <br /> Mailing Address: (See instructions.) <br /> Street <br /> City State Zip <br /> Site Contact Person: r^ � (See instrzrctions) <br /> First Name Last Nam_ <br /> Contact Person Address: 3S,6- <br /> Street <br /> 5Street <br /> Cit} State <br /> Zip <br /> !26 7 el l– ISt; 1 <br /> Contact Person Phone Nunibcr. <br /> Fax Numb_r: <br /> Are Code Phone Number -- <br /> •.:ontact Person Business Email Address. Area Cnrlr. Fax Number <br /> Preferred Primary Communication: Mail <br /> (] Eniai] <br /> Legal Business Owner(not property own r): tl _.Sl-f (See instructions.) <br /> �i c`�L <br /> tuner Address_ 1r}N t e (,;lig <br /> Street C�Ctr <br /> )wrier Phone Number: (c7'Lf rj gr-j ( ,bl City State Zip <br /> Area Code Phone Number <br /> tandard Industrial Classification(SIC)C de for the Site: rj I <br /> (4'D! it Number See ins <br /> DISC 1358 10/03 l' — tractions.) <br /> Z0 39dd 3MMAIMA Z90ZZEHOZ LT:TZ b00Z/ZZ/0Z <br />