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OMB#2050-0024, Expires 01/31/2017 <br /> SEND <br /> COMPLETEDy <br /> FORM TO: United States Environmental Protection Agency I <br /> The Appropriate RCRA SUBTITLE C SITE IDENTIFICATION FORM <br /> State or Regional <br /> Office. <br /> 1. Reason for Reason for Submittal: <br /> Submittal IN 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(to 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 State equivalent <br /> LQG regulations) <br /> 2. Site EPA ID EPA ID Number C I A I L I 1 0 1 0 1 12 1 6 1 9 LLL7 J 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 Stockton <br /> City,Town, or Villa e: County: San Joaquin <br /> State: CA Count : USA Zip Code: 95215 <br /> 5. Site Land Type ❑✓ Private E]County ❑District ❑Federal ❑Tribal ❑Municipal ❑State ❑Other <br /> 6. NAICS Codes) A. 4 1 2 3 9 1 3 1 0 C. <br /> for the Site <br /> (at least 5-digit B. I I I I I ( D. <br /> codes <br /> 7. Site Mailing Street or P.O. Box: 3927 Clark Drive <br /> Address Stockton <br /> Ci ,Town,or Village: <br /> State: CA Country: USA 95215 <br /> Zi Code: <br /> 8. Site Contact First Name: Charina Ml: 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 Country: USA Zip Code: 95742 <br /> Email: cgaspay@schn.com <br /> Phone: 916-204-7625 Ext.: <br /> Fax: <br /> 9. Legal Owner A. Narne of Site's Legal Owner: Pick-n-Pull Auto Dismantlers, Stockton LLC Date Became <br /> and Operator Owner: <br /> of the Site Owner <br /> Type: Private ❑ County El District 0 Federal 0 Tribal Municipal 0 State 0 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 countEX:,USA Zip Code: 95670 <br /> B. Name of Site's Operator: Pick-n-Pull Auto Dismantlers, Stockton LLC Date Became <br /> O erntor: <br /> Operator � <br /> Type: �Private O County O District O Federal O Tribal 0 Municipal O State 0 Other <br /> EPA Form 8700-12, 8700-13 A/B, 8700-23 Pagel of 4 <br />