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Permanent State ID Number Application <br /> DTSC Form 1358 (Revision 05/20) Page 2 of 2 <br /> 10. Site Contact Person: <br /> First and Last Name <br /> Contact Person's Address: <br /> Street <br /> City State ZIP Code <br /> Contact Person's Phone Number: L ) <br /> Area Code Phone Number Extension <br /> Fax Number: ( ) <br /> Area Code Fax Number <br /> Contact Person's Business Email Address: <br /> 11 . Legal Business Owner (not property owner): <br /> First and Last Name <br /> Owner's Address: <br /> Street <br /> City State ZIP Code <br /> Owner's Phone Number: ( ) <br /> Area Code Phone Number Extension <br /> Fax Number: ( ) <br /> Area Code Fax Number <br /> 12. Standard Industrial Classification (SIC) Code for the Site (4-digit number): <br /> 13. Certification: I certify under penalty of law that the information on this document was <br /> prepared to the best of my knowledge and belief to be true, accurate and complete. <br /> Signature (handwritten): Date: <br /> Name (print): Title: Phone: <br />