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Reliance Intermodal Inc Record ID# PR0539220 <br /> June 6, 2019 Program: HW <br /> 1919 E Dr Martin Luther King Jr Blvd, Stockton, CA 95205 <br /> PHOTO 1: DTSC form 1358 was filled out and emailed to the DTSC while inspector was on site to reactivate State ID: CAL000416471 <br /> PERMANENTSTAT E NE1w 1 UaMm BnEPPRlyRmEg ne.,ru mm spay o, NUMBER A_P-PL_IC- r^wNp--lo."A "nATIOn,.,. <br /> w..."... <br /> ew nom annm caarmrna ID as <br /> w" <br /> R a 1 nurrrhC/: A. I I NPVPf ha/RCRAd a nu h. a aha rd tc: pp ter <br /> _ /os 9mn/er lhon X00 Fg uh 1�:1........ <br /> ad C. 1 +TynaPoryr <br /> rN_I (1 J(UIP .no el,,4rotlae c d w' l rNh 'non/ fo's U ow no,or quo ones-an.- <br /> Walee Four B>Oly 2/ a=pnID nnmho. +s wanln Ilvny In Oa CFR 261.6 <br /> EHGES i STA �- Rnlyne): qam cltenging Iho business name onl /'v Vengcalion Questionnaire e. ❑ Other <br /> y,no ownership change. <br /> 6 SitelFaeltity/Business Name(Include De). <br /> 7.Site Location: 2-4 <br /> f <br /> Sime[ <br /> CI Stale <br /> 8.(a)Federal Employer ID Numbers/r rfCoknn 721p Code <br /> (b)Board of Equalization Fee Account Number county <br /> ((b)is only required rrom enerafors or reefer then 5 tons er calendar <br /> g g <br /> year.) <br /> g.Mailing Address: <br /> S rest <br /> ---------- <br /> state21CaCa e� <br /> 10. Site Contact Person: <br /> I Name Last Nama 4k <br /> Contact Person Address: L7_ <br /> beet \ <br /> y State �� di7� <br /> Contact Person Phone Number: .^ ZIP Code <br /> f I 12o )-�=���'' Fax Number:C2 <br /> Area Code Phone Number <br /> Code Fax Number <br /> Contact Person Business Email Address: Area <br /> t <br /> 11. Legal Business Owner(not property owner): LIAi� <br /> Owner Address:Jill l <br /> treet . dW F <br /> l5/f / 1 <br /> S <br /> �y w^ Owner Phone Number. G3n1, <br /> 1 Citi State IP Code <br /> La �-"'_' l"S'�c i^',,��r'> FaX Number. Fin: I ALN, -O L/7 <br /> res Code Phone Number <br /> Area Code Faz Number"-"–'—�— I <br /> 12. Standard Industrial Classification(SIC)Code for the Site: <br /> L� (4-Digit Number) <br /> r�/�o f 13. Certification:/cerii/y undeFpenalty o/law that the infomlation on this document wasprepared to the best of my knowledge and <br /> L be/iello be true,accurate and complete. <br /> SIGNATURE(handwritten) ` fir / <br /> / 9 f � Date G/ld d <br /> n l� Name(print)-i L� �/N� r7 <br /> y Title `' Phon //",p <br /> DTSC Form 1358(09/18) <br /> Page 3 of 3 <br /> Tricia Dai, EHS Page 1 of 1 <br />