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APPLICATION FOR HAZARDOUS MATERIALS …

STATE OF CALIFORNIA. DEPARTMENT OF CALIFORNIA HIGHWAY PATROL. APPLICATION FOR HAZARDOUS MATERIALS TRANSPORTATION LICENSE. CHP 361M (Rev. 6-12) OPI 062 Please print or type REASON FOR APPLICATION APPLICANT NAME (COMPANY NAME) FEDERAL EMPLOYER NUMBER (EIN). (IF NONE, LEAVE BLANK). Initial license ($ ). ADDITIONAL NAME THE COMPANY IS DOING BUSINESS AS (IF NO DBA LEAVE BLANK) SOCIAL SECURITY NUMBER (SSN). New license - majority change in (MUST BE PROVIDED FOR INDIVIDUALS). ownership or control ($ ). Renewal ($ ) TELEPHONE NUMBER (INCLUDE AREA CODE).

phmsa expiration date. federal motor carrier safety administration (fmcsa) hazardous materials safety permit number and expiration date (if applicable) fmcsa expiration date. specialized highway routing requirement information. hazardous material shipments indicated below are subject to specialized routing requirements. to be placed on the ...

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