HomeMy WebLinkAboutBUS OWNER/OPERATOR ID 9/2/2011UNIFIED PROGRAM CONSOLIDATED FORM
FACILITY INFORMATION
BUSINESS OWNER/OPERATOR I- DENTIFICATION
Page of
L IDENTIFICATION
FACILITY ID # 13F.GINNING [)All.: U0 ENDING DATE 101,
Agency Use Only) 77- H
BUSINESS NAME (Same as h'acility Name or DBA - Doing Business As) 3 BUSINESS PHONE 102
Pick Your Part Auto Wrecking 661 ) 833 -5656
BUSINESS SITE ADDRESS 103. BUSINESS FAX 10'-a
5311 S. Union Ave 661) 837 - 4881„_.
BUSINESS SITE' CITY W. ZIP CODE 105 COUNTY 'tom.
0K
Bakersfield CA 93307 Kern
DUN & BRADSTREE.T 106. PRIMARY IC 107 PRIMARY NAICS 07a.
C 2 L
BUSINESS MAILING ADDRESS osa.
BUSINESS MAILING CITY 1086. STATE7 °80. 7IP CODP
BUSINESS OPERATOR NAME 109, 13LJSINFSS OPERATOR PHONE 110
II. BUSINESS OWNER
OWNER NAME 111. OWNER PI IONF 112.
Pick Your Part Auto Wrecking a division of LKQ Corp 714 385 -1200
OWNER MAILING ADDRE..SS 113.
2931 E. White Star
OWNI R MAILING CITY 114. STATE 115 ZIP CODE 116
knaheim CA 92806
III. ENVIRONMENTAL CONTACT
CONTACT NAME 117 CON"IACI' PHONE 118.
Paul Se al 714 ) 920 -9146
CONTACT MAILING ADDRESS 119. CONTACT EMAIL 119a
2931 E. White Star pesegal@lkgcorp.com
CONTACT MAILING CITY 120. STATE 121 ZIPCODF 122
Anaheim CA 92806
PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY -
NAME 123. NAME 157
Manual Gonzales Paul Se al
TITLE 124. TITLE 121).
Manager Director of Enviromental Affairs
BUSINESS PHONE 125. 13USINESS PHONE, 130.
661) 833 -5656 714 385 -1200 ext 8512
24- 1-IOlJR PI iON F 126. 24- 1 -IOUR PHONE 131.
661 ) 427 -9054 714 920 -9146
PAGER # 127. PAGER # 132.
ADDITIONAL LOCALLY COLLECTED INFORM (NNED 133.
Billing Address: 1
Property Owner:
lJ
j ; y Phone No.: ( )
TIME
n
Certification: Ba>5 t1 o t quir:y\of thus individuals responsibl for obtaining the information, I certify under penalty of law that I have personally examined and
n familim wit c into a . bmitted a believe the informati n is tn1c, accurate, and complete.
SIGNA'I) F" OI OWNE A' 1 OR D .'ICiNA'I'ED REP 'SI`NTATNE. DATE 114 NAMI: OI-' DOCUMENT PREPAREIZ 135.
8/30/2011 Peggy Stuflick
NAMI 01- SIG f (print) 136. TITLE OF SIGNER 137
Paul Se al ( Director of Environmental Affairs
J
11w1`730 UPCF Rev. (1212007) - 1/2 www.unidoes.org Effective 01 /17/08