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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> (9/23/2011 - 11:19:10 AM) <br /> Page of <br /> 1. IDENTIFICATION <br /> FACILITY ID# 9611 l 1 BEGINNING DATE NSA 100 ENDING DATE NSA 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> PICK N PULL AUTO DISMANTLER STKN LLC 209.462-1927 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a <br /> 3927 CLARK DR Not Collected <br /> BUSINESS SITE CITY104 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95205 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> 01-332-4418 5015 Not Collected <br /> BUSINESS MAILING ADDRESS 108a <br /> 10850 GOLD CENTER DR <br /> BUSINESS MAILING CITY 1081 STATE 108c ZIP CODE 10E <br /> RANCHO CORDOVA CA 95670 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> PICK N PULL AUTO 209-462-1927 <br /> DiCMANTI XRB.RT(tt:KTnN LLC <br /> IT. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> NORPROP INC. 916.689-2000 <br /> OWNER MAILING ADDRESS 113 <br /> 10850 GOLD CENTER DRIVE <br /> OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 <br /> RANCHO CORDOVA CA 95670 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> CHRIS ORSOLINI 916.496.6768 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a <br /> 10850 GOLD CENTER DR SUITE environmentalQpicknpull.com <br /> CONTACT MAILING CITY 120 1 STATE 121 ZIP CODE 122 <br /> RANCHO CORDOVA CA 95670 <br /> IV. EMERGENCY CONTACTS <br /> NAME MARTHA MILLER 123 NAME KEVIN BOCHE 128 <br /> 777'[.E MANAGER 124 TITLE 129 <br /> AREA MANAGER <br /> BUSINESS PHONE 209.462.1927 125 BUSINESS PHONE 209-462.1927 130 <br /> 24-HOUR PHONE 916-705.1278 126 24-HOUR PHONE 916.462.1927 131 <br /> PAGER/CELL# NSA 127 PAGER/CELL# 916.462.1927 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,l certify under penalty of law by signing below or certifying by the <br /> established processes on the Administering Agency's HMMP Compliance Website that I have personally examined and am familiar with the informaiton submitted and <br /> believe the information is true,accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 1171,13 OF SIGNER 137 <br /> UPCF(Rev.12/2007 <br />