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.
Title: APPLICATION FOR HAZARDOUS MATERIALS TRANSPORTATION LICENSE, CHP 361M Author: OK Subject: Revision 7-10 - created PDF, updated mailing address, removed heavy lines and right/left borders - ok \r\n\r\nRevision 06/12 - Added SSN Field, deleted and reworded 'chp use only' fields and updated certification informatiaon - jc \r\n\r\nFile Vrsn : 12/\ 12 - …
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