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OMB# 2050-0024; Expires 01 /31 /2017 <br /> SEND <br /> COMPLETED a '° "'�. <br /> FORM TO: United States Environmental Protection Agency <br /> The Appropriate RCRA SUBTITLE C SITE IDENTIFICATION FORM <br /> State or Regional <br /> Office. <br /> 1 . Reason for Reason for Submittal : <br /> Submittal ® To provide an Initial Notification (first time submitting site identification information / to obtain an EPA ID number <br /> for this location) Currently have State EPA ID and need Federal <br /> MARK ALL O To provide a Subsequent Notification (lo update site identification information for this location) <br /> BOX(ES) THAT ❑ As a component of a First RCRA Hazardous Waste Part A Permit Application <br /> APPLY ❑ As a component of a Revised RCRA Hazardous Waste Part A Permit Application (Amendment # ) <br /> ❑ As a component of the Hazardous Waste Report (If marked, see sub-bullet below) <br /> ❑ Site was a TSD facility and/or generator of >1 ,000 kg of hazardous waste, > 1 kg of acute hazardous waste, or <br /> >100 kg of acute hazardous waste spill cleanup in one or more months of the report year (or Slate equivalent <br /> LQG regulations) <br /> 2. Site EPA ID EPA ID Number I C I AlL11 0 1 0 1 12 16 1 9 13 17 1 5 <br /> Number <br /> 3. Site Name Name: Pick-n-Pull Auto Dismantlers, Stockton LLC <br /> 4. Site Location Street Address : 3927 Clark Drive <br /> Information City, Town, or Village: Stockton Coun : San Joaquin <br /> State: CA Count : USA jZIp Code: 95215 <br /> 5. Site Land Type ❑✓ Private ElCounty ❑ District ❑Federal ❑ Tribal ❑ Municipal ❑State ❑ Other <br /> 6. NAILS Code(s) A. 4 2 1 3 9 1 3 0 C, <br /> for the Site <br /> (at least 5-digit B. I I I o. <br /> codes <br /> 7. Site Mailing Street or P.O. Box: 3927 Clark Drive <br /> Address City, Town, or villa e: Stockton <br /> State: CA Count : USA 1ZIp Code: 95215 <br /> 8, Site Contact First Name: Charing I MI: M Last: Gaspay <br /> Person Title: Reg , Environmental Manager <br /> Street or P.O. Box: 12000 Folsom Blvd <br /> City, Town or Village,. Rancho Cordova <br /> State: CA Count : USA 1ZIp Code: 95742 <br /> Email : cgaspay@schn.com <br /> Phone: 916-204-7625 Ext. : Fax: <br /> Date Became <br /> 9. Legal Owner A. Name of Site's Legal Owner: pjck-n-Pull Auto Dismantlers, Stockton LLC Owner: <br /> and Operator Owner <br /> of the Site Type: ❑✓ Private ❑ County ❑ District ❑ Federal ❑ Tribal ❑ Municipal ❑ State ❑ Other <br /> Street or P.O. Box: 10860 Gold Center Drive, Suite 250 <br /> City, Town, or Village: Rancho Cordova Phone: 916-858-1300 <br /> State: CA Count : USA Zip Code: 95670 <br /> B. Name of Site's Operator: Pick-n-Pull Auto Dismantlers, Stockton LLC Operator: <br /> Date Became <br /> Operator 171 <br /> Type: Private ❑ County ❑ District ❑ Federal O Tribal ❑ Municipal ❑ Stale ❑ Other <br /> EPA Form 8700-12, 8700-13 A/B, 8700-23 Pagel of 4 <br />