Transcription of APPLICATION FOR HAZARDOUS MATERIALS …
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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). Name Change Late renewal ($ ). PREVIOUS NAME. Duplicate - license lost or MAIN OFFICE STREET ADDRESS CITY STATE ZIP CODE. destroyed ($ ). Replacement - correction or MAILING ADDRESS (IF DIFFERENT FROM STREET ADDRESS) CITY STATE ZIP CODE. change of name and/or address only (no fee, attach current license). OWNERSHIP INFORMATION (MARK ONLY ONE) MAIL LICENSE ATTENTION: Amended - minority change in CORPORATION LIMITED LIABILITY COMPANY (LLC) PARTNERSHIP.
pipeline and hazardous materials safety administration (phmsa) registration number and expiration date. 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
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