Sweetser & Associates - Authorization Form - 2025-03-21
Office of Environmental Information Management
Rev. 11/21/2018
AUTHORIZATION FORM
This is to certify that I, ___________________________________________________________
Authorized Business Representative
of ____________________________________________________________________________
Name of Site/Facility/Business
authorize ______________________________________________________________________
Name of Consultant/Authorized Representative
of ___________________________________________________________________________________________
Name of Consultant/Authorized Representative’s Business
to conduct business with the Department of Toxic Substances Control on my and/or company’s
behalf.
Check any that apply.
_____Complete and sign the Permanent State ID Number Application (DTSC Form 1358) for the
purpose of obtaining, reactivating, inactivating or updating an EPA ID number.
_____Complete the electronic Verification Questionnaire (eVQ).
Site/Facility/Business Name: ______________________________________________________
Federal Employer Identification Number (FEIN): _______________________________________
Site Location: __________________________________________________________________
Street
__________________________________________________________________
City State Zip Code
Phone Number: ________________________________________________________________
Email: ________________________________________________________________________
Signature (handwritten)__________________________________________________________
Title: __________________________________________________ Date: __________________
Scott Carroll
Costa Mesa Sanitary District
Larry Sweetser
Sweetser & Associates, Inc.
Costa Mesa PHHWCF CAH111001464
95-6003939
7571 Lampson Avenue
Garden Grove CA 92841
949-645-8400
scarroll@cmsdca.gov
General Manager
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Docusign Envelope ID: 16FD4B57-8950-47DD-AA42-FF8D01703784
3/21/2025