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All Pro Coatings Record ID# PR0518145 <br /> May 24, 2019 Program: HW <br /> 2650 Wigwam Dr Suite N. Stockton, CA 95205 <br /> PHOTO 3: DTSC form 1358 filled out for submission to the DTSC while inspector was on site to apply for a State ID number. <br /> E NUMB ER REQUEST NERVI NENi STATE ID NUMBE <br /> )L I l a aV I—� '- r R APPLICATION <br /> R U for a naw perrnananl Ca Ir : <br /> /rY b r a nnw number A Navel h I 1 a <br /> s JenerafPg ampler rl(arr D <br /> *�: L b/_ r 11 tl/J1 PP=rrn°nfh Pl=asr• rcnm kfr u/R R U. lf. [ a - maven C n n <br /> Plolu d 0-_l:/ urlwrlh M <br /> CHANGES TO STATUIN, <br /> bahrlerw EPA IO=_urntwl�a� r�,r, <br /> For exr1 am IU number OR INFOR gTION FOR ----I <br /> rl 2. I am u TIN ----_ _ <br /> ptlaling the mailing address an,or con <br /> IJ 3. 1 am inacrivaring IIre I0 number. bct inlormellon only. <br /> i_l 4 I am reactivating Ihrs ID number Rea <br /> busmess name only,n1Piaew sawn noel: A p V_,_aa Ouap <br /> me ow—Nponanpe4onnane g . <br /> 6.Site/Facllify/ausiness Name(Incluse DSA --- <br /> ) .moi/ <br /> e.(a)Federal Em IortY <br /> p yer ID Number Stare <br /> -�---�(b)Board of Equal liatpn Fppe Arrqunl Number Curnll <br /> ((b)Is only raeuiretl/rwn genaralors a/gfeater than S Ions per carandar v- <br /> 9.Mailing Address: � Sd �i / <br /> J[ <br /> Slate L Cooe <br /> 10. Site Contact Person: yvy <br /> First Name r <br /> Last Name <br /> Contact Person Address: <br /> City <br /> �a t 95a�2 <br /> -" Lp Code <br /> Contact Person Phone Number:( g„�u-g7�i S <br /> Area Code Phone Number Fax Number'. <br /> Area Code Fax Number <br /> Contact Person Business Email Address: yy'7 <br /> rti <br /> 11. Legal Business Owner(not Property <br /> y--eer):: '7/m 'r <br /> Owner Address: y <br /> .(�1 /�/( / jme2� ^1,/ ',4 q, ))- <br /> p <br /> Owner Phone Number: 9. -e�s Fax Number: tate i. code <br /> Area Code Phone Numbar Area Code Faz Number <br /> 12. Standard Industdal Classification(SIC)Code for the Site: _ (4-Digit Number) <br /> 13. Certification:/certify under penalty of law that the information on this document was prepared to the best of my knowledge and <br /> belief to be true,accurate✓andel plete. P <br /> SIGNATURE(handwritten) "'e �} Date <br /> Name(print) ljI' �Ltr'2r Title CiW411/ Phon. �by�l7Z <br /> DISC Form 1358(09/18) <br /> Page 3 of 3 <br /> Tricia Dai, EHS Page 3 of 5 <br />