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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: Bill Stoermer <br /> First and Last Name <br /> Contact Person's Address: 2060 E. Fremont Street <br /> Street <br /> Stockton CA 95205 <br /> City State ZIP Code <br /> Contact Person's Phone Number: (209 ) 451 -1459 <br /> Area Code Phone Number Extension <br /> Fax Number: 2c O9 } 451 -1610 <br /> Area Code Fax Number <br /> Contact Person's Business Email Address: BStoermer53@gmali.com <br /> 11. Legal Business Owner (not property owner): Fremont Plaza Ace Hardware, LLC <br /> First and Last Name <br /> Owner's Address: 2060 E. Fremont Street <br /> Street <br /> Stockton Ca 95205 <br /> City State ZIP Code <br /> Owner's Phone Number: (209 ) 481 -1459 <br /> Area Code Phone Number Extension <br /> Fax Number: (209 ) 481 -1610 <br /> Area Code Fax Number <br /> 12. Standard Industrial Classification (SIC) Code for the Site (4-digit number): 5251 <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 /> June 30, 2020 <br /> Name (print): Bill Stoermer Title: owner Phone: 209-612-5573 <br />