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Perfection Auto Body Inc Record ID# PR0528264 <br /> 1538 E Nellis Ste B Stockton, CA 95205 Program: HW <br /> July 2, 2019 <br /> PHOTO 1: DTSC form 1358 was filled out and emailed to the DTSC while inspector was on site to reactivate State ID: CAL000419910 <br /> adNwNa_e.Na�.E.,wrarrm.�lal e.w�r <br /> PERMANENT STATE ID NUMBER APPLICATION <br /> R rwck mi n ¢olr - <br /> f 1 nm aPPMng br a neW pammneut Calltentio 10number as a M1azaMwa waste r:Oongnfer _' <br /> Rae .Tnngpertur _ - <br /> on fp a new number A L�Nevar had a number 8 1:",aunlnaas moved C !!legal pvmer N bvsur¢+.s Wmlwf � <br /> o_== <br /> u rt�� � Ma 4 'fl Ire kg o/RORA lafzertlnrrs wasfa nn r lien Ilressa haranpus wash ns,wl rn ag r:F 2af s ' <br /> �rur (1 drrd(tll P r nrcv ,Ala 'on Pin a ronrr BTgp 12Iru a ledmnl Eis4 l0 n+nnOur <br /> CHANGES TO STATUS OR NFORMATION FOR AN EXISTN STATE ID N MBE <br /> Fu.emsbng to number C A L L c' ��,-Ll--A , — > <br /> O 2 1 am updating the mailing address-oto,---mom,mallon only. % ` <br /> 3 tam machvahng Ih,s ID mimbpr ' <br /> r�4I dm reaclivahng this 10 number Reason 4,--ae!ect ane)'. A K Vecanfimo Oueshonnmre a.X. Jme, <br /> am changing the busmess name only,no ovmership rhange <br /> s.sdalFaalur/auarnessName(mcwdaoeA). 1-1'1 tt c`•lo . /`u�t7� I��e(.1 ��C _ <br /> i Site Looabon. I - <br /> c� c-city elate zip code co•,��. - <br /> 1 8(a)Federal Employer ID Number •-t 1 1 Z E S (b)Board of Equall28Imo Fee Account Number _ <br /> ((b)is only required from gen:tors of greater than 51—per rale 1 <br /> IHo vs=°o <br /> oPo�uls �` 9 Mailing Address: <br /> Streei,fz iz,r� C A- 9 9-I Z <br /> vO.adO _ -- <br /> a.o � clry st 1 7ip coo - <br /> eu!vow <br /> 10.Site Contact Person: <br /> First Name l Last Name <br /> ` Contact Person Address: 2-C1 C wit (` C- y TT <br /> Street �tcl 2. ? <br /> [ 7) 1 <br /> ` _r Zip Code - <br /> City State <br /> Contact Person Phone Number.( Fax Number Are( as Fax Number <br /> Area Cod. Phone Numb}eTr (` <br /> Contact Person Business Email Address: e L i`Q CL"' hgf roclI f O <br /> I I Legal Business owner(not property owner): /•�'��(r�L i `�Y�t .F�, �}•� ® ,( <br /> Owner Address: / c�brL YF1l C(SL" 2 _ <br /> I Street <br /> City State Zp Code <br /> mber. (LW Z cl Nt ct Fax Number: <br /> Owner Phone Nu ) Are CaUode Fax Number <br /> Area Code Phone Number <br /> 1Z Standard Industrial Class cation(SIC)Code for the Site: 5 Z (4-Digit Number) <br /> 13 Certification:/Certify under penalty of faw that rmatlOn on this document was prepared to the best of myknowledge and <br /> belief to be true,accurate and complete. 7- 2 I C_ <br /> Date <br /> • <br /> SIGNATURE(handwritten) _ <br /> � <br /> Name(print) l Ml L Tttle 1G�Pl Phone " 2 � <br /> DTSC Form 1358(09/18) <br /> Page 3 of 3 <br /> Tricia Dai, EHS Page 1 of 3 <br />