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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 /> Jeremy Clarke <br /> First and Last Name <br /> Contact Person's Address: <br /> 3032 S. EI Dorado St. <br /> Street <br /> Stockton CA 95206 <br /> City State ZIP Code <br /> Contact Person's Phone Number- ( 88 ) 234-2727 6478 <br /> Area Code Phone Number Extension <br /> Fax Number: ( ) <br /> Area Code Fax Number <br /> Contact Person's Business Email Address: <br /> jclarke@qualitydistribution.com <br /> 11. Legal Business Owner (not property owner): <br /> Winsome Enterprises, Inc. <br /> First and Last Name <br /> Owner's Address: <br /> 415 Lemon Ave. <br /> Street <br /> Walnut CA 91789 <br /> City State ZIP Code <br /> Owner's Phone Number: (909 ) 594-2855 <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): 4212 <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 (handwritteFl —_`'—� _ Date: 11/16/2020 <br /> Name (print): <br /> Jeremy Clarke Title: Terminal Manager Phone: 888-234-2727 <br />