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RECEIVED VIA EMAIL ON 7/8/2022 <br /> State of California California Environmental Protection Agency <br /> PERMANENT STATE ID NUMBER APPLICATION Department of Toxic Substances Control <br /> DTSC Form 1358 (Revision 12/2021) Page 2 of 2 <br /> F10. site contact Person: Francisca Lopez <br /> First and Last Name <br /> Contact Person's Address: 835 E. Lodi Ave <br /> Street <br /> Lodi CA 95240 <br /> City State ZIP Code <br /> Contact Person's Phone Number: 209 3314321 <br /> Area Code Phone Number Extension <br /> Fax Number (optional): 209 <br /> Area Code Fax Number <br /> Contact's Business Email Address: d.dregans09 a@gmail.Com <br /> 1 11. Legal Business Owner (not property owner}: Francisco Lopez <br /> Owner's Address: 885 E. Lodi Ave <br /> Street <br /> Lodi CA 95249 <br /> City State ZIP Code <br /> Owner's Phone Number: 209 3346126 <br /> Area Code Phone Number Extension <br /> Fax Number (optional): (_} <br /> Area Code Fax Number <br /> 12. Standard Industrial Classification (SIC) Code for the Site (4-digit number): 7538 <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 believed to be true, accurate and complete. <br /> Signature:� 617 Date: a <br /> FranCl co Lopez Owner 2093346126 <br /> Name (print): Title: Phone: <br /> Site/Facility/Business Name (include DBA): <br />