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RECEIVED BY SJC EHD ON 5/3/2019 <br /> OMB#2050-0024; Expires 05/31/2020 <br /> United States Environmental Protection Agency <br /> RCRA SUBTITLE C SITE IDENTIFICATION FORM <br /> 1. Reason for Submittal (Select only one.) <br /> Obtaining or updating an EPA ID number for an on-going regulated activity that will continue for a period of <br /> time. (Includes HSM activity) <br /> Submitting as a component of the Hazardous Waste Report for 2017 (Reporting Year) <br /> ❑� Site was a TSD facility and/or generator of>1,000 kg of hazardous waste,>1 kg of acute hazardous <br /> waste,or>100 kg of acute hazardous waste spill cleanup in one or more months of the reporting year <br /> (or State equivalent LQG regulations) <br /> Notifying that regulated activity is no longer occurring at this Site <br /> Obtaining or updating an EPA ID number for conducting Electronic Manifest Broker activities <br /> Submitting a new or revised Part A Form <br /> 2. Site EPA ID Number <br /> C A I R 0 0 0 1 2 2 1 9 1 7 3 1 2 <br /> 3. Site Name <br /> CVS PHARMACY#3908 <br /> 4. Site Location Address <br /> Street Address 1885 W 11TH ST <br /> City,Town,or Village TRACY County 077 <br /> State CA Country US Zip Code 953760000 <br /> S. Site Mailing Address ❑ Same as Location Address <br /> Street Address 1 CVS Drive MC2340 CA95376 CA077US 1 <br /> City,Town,or Village Woonsocket <br /> State RI Country US Zip Code 02895 <br /> 6. Site Land Type <br /> Private County District Federal Tribal Municipal State Other <br /> 7. North American Industry Classification System(NAICS)Codes)for the Site(at least 5-digit codes) <br /> A. (Primary) 446110 C• <br /> B. D. <br /> EPA Form 8700-12,8700-13 A/B,8700-23 SI Page 1/6 <br />