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OEPARTMKNT OF CALIFORNIA HIGHWAY PATROL APPLICATION FOR HAZARDOUS MA ERIAL TRANSPORTATION LICENSE' Please print or type CARRIER'9 COMPANY NAME TQLQ 209 NUMBER STOCKTON CONTRACTING GROUP, INC. 1 P"O ) 462-5082 IF THIS ISA HAM[ CHANGE, ENTER PREVIOUS NAME NONE DOING BUSINESS AaDEA NAE MAIN OFFICE STREET ADDRESS CITY STAT[ ZIP COOK MAILING AODRQSS CITY STATE ZIP COOK 1000 N. Union St. Stockton Ca. 95205 LEGAL OWNER PERSON, FIRM, COMPANY, ASSOCIATION, OR CORPORATION IF DIFFERENT THAN CARRIERS NAM[ CHP CARRIER NUMBER IF KNOWN ICC NVMBERPUC NUMBER CA— MC— REASON FOR APPLICATION ® Initial license ❑ Renewal ❑ Duplicate—license lost or destroyed ❑ Owner change ❑ Late renewal ❑ Replacement—correction or change of name and/or address CMP HAZARDOUS MATERIALS LICENSE NUMBER EXPIRATION DATE CALIFORNIA HAZARDOUS WASTE HAULER REG. NO EXPIRATION DATE TYPE OF LICENSE CHUCK ONE) Explosives subject to Division 14, California Vehicle Code;materials subject to Section 31302, California Vehicle Code,and other hazardous materials(HMX) ❑ (CHP Motor Carrier Safety Unit approval required) Other hazardous materials(HMO) Hazardous materials in certified waste hauler vehicles only (fae exempt) (HMW) ❑ (State Department of Health Services Hazardous Waste Hauler Registration Number must be listed above) APPLICANT BACKGROUND Yes No a. Has the applicant ever been issued a similar license by the Department of California Highway Patrol, another state agency,another / state,or the Federal Government? If"yes"explain on reverse. ✓ b. Has the applicant ever had any license denied,suspended or revoked by the Department of California Highway Patrol,another state agency,another state,or the Federal Government? If"yes",explain qn reverse. c. Has the applicant ever been a partner, officer, director or controlling shareholder in a company or corporation whose license was denied, suspended, or revoked by the Department of California Highway Patrol, another state agency, another state, or the Federal ✓ Government? If"yes", explain on reverse. CERTIFICATION AND APPLICANT'S SIGNATURE It is agreed that the licensed activity will be conducted in compliance with all applicable laws and regulations, and that the applicant is aware of all applicable California laws and regulations pertaining to motor carrier safety and hazardous materials transportation. It is understood that violation of any law or regulation may result in the filing of a criminal action in a court of law and the filing of an administrative action to suspend or revoke the license. It is also understood that misrepresentation of a material fact in conjunction with this application is a misde- meanor violation of the California Vehicle Code and may result in the denial or revocation of the license. EIONATYRQ OF YTNRIZ CO OEPRESENTATIVE PRI OR TYPE NAM[ AND TITLE 5,07M�H DATE Jerry Joy Vice President 1/16/89 AIL OF HE LOWI FORMS WITH ANY REQUIRED FEE TO: FOR CHP USE ONLY LIFORNIIA HIGHWAY PATROL MOTOR CARRIER 199U ANCE OF LICENSE RECOMMENDED P. . BOX 942090 SAFETY UNIT SACRAMENTO, CA 94298-0001 APPROVAL ❑ Yes ❑ No—explain on reverse M C95 SIGNpTV RQ 1. CHP 361 M, "Application for Hazardous Material Transportation License", MCB'S PRINTED NAME 2. CHP 362, "Carrier Profile Information". I.D. NUMBKR LOCATION CODE DATE TO BE COMPLETED BY THE CALIFORNIA HIGHWAY PATROL ACCOUNTING I DATE AMOVNT LICENSE NVMBER DATE 1sSuED EFFECTIVE DATE DATE EXPIRES USE ONLY CASHIER CHECK DATE CHECK NUMBER CHP CARRIER NV MOER CONTROL NUMBER CA— CHP 361M (Rev 348) ON 061 Use previous editions until depleted.