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OMB#: 2050-0028 Expires 06/30/2009 <br /> �4@U 9 Tq�T <br /> SEND COMPLETED United States Environmental Protection Agency <br /> FORM TO: <br /> The Appropriate State or oma$ <br /> EPA Regional Office. RCFA SUBTITLE C SITE ENTIFICATION FORM <br /> 1. Reason for Reason for Submittal: <br /> Submittal ❑To provide Initial Notification of Regulated Waste Activity(to obtain an EPA ID Number for hazardous <br /> (See instructions waste,universal waste,or used oil activities) <br /> on page 13.) <br /> O To provide Subsequent Notification of Regulated Waste Activity(to update site identification information) <br /> MARK ALL BOX(ES) <br /> THAT APPLY 13As a component of a First RCRA Hazardous Waste Part A Permit Application <br /> ❑As a component of a Revised RCRA Hazardous Waste Part A Permit Application(Amendment#_) <br /> ❑As a component of the Hazardous Waste Report <br /> 2. Site EPA ID EPA ID Number <br /> Number(page 14) IC I A 1 0 1 1 0 1 0 1 0 11 1 1 4 12 11 3 1 3 1 1 1 <br /> 3. Site Name Name: Dana Structural Manufacturing, LLC <br /> (page 14) <br /> 4. Site Location Street Address: 1550 Industrial Drive <br /> Information <br /> (page 14) City,Town,or Village:Stockton State: CA <br /> County Name: San Joaquin Zip Code:95206 <br /> 5. Site Land Type Site Land Type: p Private ❑ County ❑ District ❑ Federal ❑ Indian ❑ Municipal ❑State ❑ Other <br /> (page 14) <br /> 6. North American A. B. <br /> Industry 1 3 1 3 1 6 1 1 1 1 2 1 1-1-1-1-1-1-1 <br /> Classification <br /> System(NAICS) C. D. <br /> Code(s)for the I—I-1-1-1-1—I I—I—I—I—I—I—I <br /> Site (page 14) <br /> 7. Site Mailing Street or P.O.Box: 1550 Industrial Drive <br /> Address <br /> (page 15) City,Town,or Village:Stockton <br /> State: CA <br /> Country: us Zip Code: 95206 <br /> First Name: MI: Last Name: <br /> 8. Site Contact Bob Cole <br /> Person Phone Number: Extension: Email address: <br /> (page 15) 260-494-9764 bob.cole@dana.com <br /> 9. Operator and A.Name of Site's Operator: Date Became Operator(mm/dd/yyyy): <br /> Legal Owner Dana Structural Manufacturing, LLC / 19 <br /> of the Site Operator Type:p Private ❑ County ❑ District ❑ Federal ❑ Indian ❑ Municipal ❑ State ❑ Other <br /> (pages 15 and 16) B.Name of Site's Legal Owner: Date Became Owner(mm/dd/yyyy): <br /> Dana Structural Manufacturing,LLC C� c• -�De) <br /> Owner Type: p Private ❑ County ❑ District ❑ Federal ❑ Indian ❑ Municipal ❑ State ❑ Other <br /> EPA Form 8700-12(Revised 7/2006) Page 1 of 3 <br />