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OCT. 2. 2009 2:24PM ITC COLLISION DIVISION NO. 719 <br /> plesae$Bntor Noe.IFormdesignedfor i7se'oneae 12 itch Wowlitar, Form Approved.OMB No.2050.0099 <br /> '��•9 GNIF0JgkVQA7ARD0U8 1•Genamior wn�'r a.Psgator aEmoganeygospensapnone a.ManiFa9IRaeaingNumner <br /> 49T2MANI1198T :3 3 1-8f/6, .e;;-0..SYE1{D . 3935406 JJK <br /> 3,GenenWo eand MeYmliAderoo OenenbfcSmAddaea(IId ooMlAanmal0npaddrerq <br /> 7,hin ifl'rATE TRUCK CX WTEr1 <br /> 841 5 HARRSP:7.1161 STREV.."t <br /> V?XAJON, (,A GGN? G <br /> aeumforg phone! <br /> 6,TransooCo OU.S.EAI Numer' ,• <br /> s7HCT'T.FtC CPAdVBIST LA1.t?fP@;R• . . ;r 4r <br /> 7.Tmmpwzra Gernmeny <br /> Name-U.S.EPAID NIm100r <br /> 9,DesipnaledF %y Hama and Bib Addreoe U.S,EPA ID Number <br /> PACIFIC plsCQkat'u teEO;( cwt <br /> 35541 e,ABT P OCE% DWO. <br /> 605 ANIPMLEM. CA•9ft, 23 <br /> Padu Parcel'' ' •@ 00) 4S9-71115 r✓, .• <br /> as �12,U,S,13070esalptlon*udiip Proper 8hyp1nq Name N¢mC paR,ID NJ 10.Conti v e d 11_TSI , 1?&i <br /> NM and PeakNg Group(ttany)) No, Type Ouagdty yypym%el, "la.Whole Codes <br /> allX tI;N1.105;'•1dt15TiF,• a?AI'hv�i•lrip➢:.•RFEn RlR1'G6i.Lp4. f$x o, 7.ii 6lfdbi 1 QY46 <br /> ialx 30 '.i a <br /> -rjw 14 <br /> • F <br /> a. <br /> 14.SOJZy Mondapg mut diens and Additional InloRnalion <br /> 2111.1 lhP: .6.3?9 , ,^^ •. �' <br /> GLW-ln 00111141^5 :6 •Pt(0T.1'C•LT' y,E E:1_l9•rl•1:..-ma <br /> TRA9Vai*t1i4T'�[�.;1.,.F,iiT1NL' '{4` 2�.:G94!S-•.7v,g•.1,�t>6 ' <br /> 15. GENERATDR'SNMFEROR'SDERTIPICATION)I hereby deolora Ulatibe oonlenle of his wnslgNApm era bayand aeonldy dasolbod above by the proper sNpbing hams,and are clasailia c2aga4 <br /> mafaad pori IaaaladpladSrped,ahq'ate le as rospoals la proper condition for hanspon aanrding to spp4taMe irrteme6onel and naaonal go'vemmenbl raguledons.l(exporiahluned and l am me Primary <br /> Expw.JIcar*thgtlhe mnlanls 011hi9 mr&Ignmantrenbrm to the terms ofthe aaaahed BPAAeyhawladgmomt o(ConsonL ' <br /> ,104 tlrat dro Wade minlmlrallDn cailOmonl ldardmed In W UR2@W(;)(HI area large gwIdily gomm"or(6)(Cl Or,a small gyaptltl geneelorl is no, <br /> emmyNOfiprofaP ped Namq <br /> Signature <br /> .. ''� Mondr Day Year <br /> "A- • <br /> _r iB.mremalanAr'S1%Areola .. <br /> le <br /> F .. OGnpq(Ia UR: ❑Eapon ban U.S, Pon aianayde:dt <br /> 3 �lanepemarN9Aabro(broxpeA4oAl : Done IJ U.S.: <br /> W n,TmnspenerACWgwkdgmant or R6caiplo(MalarHls �„ <br /> ctrmr=panarTPan:edRypaq Nama �,�. . 3ignhNlo j' • Monh Day Year <br /> Trenapater r me ped•Neme h:� �Igrld�W"ro ;•/• <br /> M&M Day ear <br /> w ' Farm <br /> T19.Dlaaepency ' <br /> Ha.Dlderepmay lndca9pn Spade 0"a* Review PWo1 Rejection ©FUN Rolodon <br /> MaMre e n Nur. <br /> 106.Allemale Ps Ilry(of GePersmr) U.B.EPAID Number <br /> J <br /> U <br /> w Fad 's Phone: _ <br /> 1 p. gna Iamele Psclary(dr Gensrabh _ na, nv PW <br /> 19.Haxardoue Waera trepan Management Malhod Codes(I.e,codes for hee red,wasto ruaenem,d,'apusal,and recycling systems) <br /> i? 1. a• d, 4. <br /> i' in 1, <br /> H.Dedghatod FadgtyOwnaror Operator.CaAifmko of receipt of hIPWRIM Wte8 l;covered by the man fssl except as noted in Item 1Ba <br /> Fnnt_d/ryped Nerrla , 9n Si alUM <br /> , r' , Merrin er <br /> / <br /> , <br /> 98B-d Z00/Z00'd OIS'1 '00 AN S1113-MONA Nde5121 000;-100-20 <br />