HomeMy WebLinkAboutCERS EXTENSION REQUESTFax Jun 28 2017 05:20pm P001/002
STANCIL'S CUSTOM WELDING AND AUTOMOTIVE
801 BRUNDAGE LANE SUITE K
BAKERSFIELD CALIFORNIA 93304
JUNE 28, 2017
ATTENTION
BAKERSRELD CITY FIRE DEPARTMENT
RE CERS ID 10626163,
I wish to request an extension to complete my CERS submission - I am in the process of requesting my
State ID number, from the Department of Toxic Substances Control . I will submit my report as soon as I
have my State |Onumber,
| apologize for the inconvenience this may cause you.
Thank You for your understanding
.
Sincerely
Fax Jun 28 2017 05:20pm P002/002
-JkCLLC V1 t,;cmiumia c:uvirrjnrnP_ntaj t-roiecijon A90ACY Department of Toxic Substances Control � HWMP
P.O. Box 806, Sacramento, CA 95812-0806
PERMANENT STATE ID NUMBER APPLICATION
Please type or neatly print in ink. Please review the fine-by-Ifirie instructions carefully.
To check on the status of your request, go to h1tfn'1/wwW �4EL �Ldtsc.ea,gov aLrid ciirk on Reports.
NEW NUMBER REQUEST,5, Check all that apply. (See instruciYons.)
)< 1, 1 am applying for a new permanent Caffornia ID number as a hazardous waste: ❑ Genemtor- ❑ Transporter
Reason for new number: A. C1 Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed
If your business generates greater than 100 kg of RCRA hazardous waste other than those hazardous waste listed in 40 CFR 261.5
subparts (c) and (d), per month, complete Form 8700-12 for an EPA (federal) 0 number.
CHANGES TO STATUS OR INFORMATION FOR AN MUM STATE 10 NUMBER (See instructions.)
For existing 10 number: C A
❑ 2. 1 am updating the mailing address and/or contact information only,
❑ 3. 1 am inactivating this IQ Number.
❑ 4. 1 am reactivating this ID Number. Reason (please select one): A. ❑ Verification Questionnaire S. ❑ Other
❑ 5. 1 am changing the business name only, no ownership change.
(See instructions.)
6. Site/Facility/Business Name (Include DBA):
7. Site Location: :&Lm aac- J'.&i'1r--
Street
k. !.'ob
City State Zip County
8, (a) Federal Employer ID Number (b) Board of Equalization Fee Account Number
((b) is only required fray m genei-afor.3 of greater then 5 tons per calendar year)
j 1-11 (See instructions,)
9. Mailing Address. Tol afin
CA I L
City State Zip
(See instructions.)
10. Site Contact Person: favc,.-A t .
First Name Last Name
Contact Person Address:
Contact Person Phone Number: r j Fax Number:
Area Code Phone Numwr Area Code
Contact Person Business Email Address:
Fax Number
Preferred Primary Cornmunit;aflon: )< Mail 0 5-mil
(See instructions.)
11. Legal Business Owner (not property owner): VC:"A
N4,rn
Street City state Zip
Owner Phone Number: IL-1.) ��i - Fax Number C___j
Area Code Phone Number Area Code Fax Number
112. Standard Industrial Classification (SIC) Code for the Site, -�L5 1— _L (4-Digit Number) (Sea ins
13. Certification; I cerffy under penalty of few that the information on this document was prepared to the best of my knowledge and
belief to b� true, accurate and camplete.
rA
SIGNATU
DATE*—
4�'
NAME (print) ;:)+CV if--A 6t-JIQ-i I— TITLE PHONE
ff-TSC Form 1358 (01117)