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It <br /> .�'fi R-0rP e4 <br /> Environmental Servicbs Division.,r J P ne 209545-0791 rFAXM1208x545 2241 <br /> W. <br /> CA <br /> 6A <br /> te'loanee W,Z58618 t. <br /> .......... <br /> arGEfdERATOR t! 1:.J h <br /> .......... <br /> W-1.1.1'...."—.4.., <br /> ..........I <br /> SName <br /> If OrIYer Sign <br /> -AN <br /> Stg 't. PO A!, <br /> :K646ctW to CA Man festilD ' <br /> W <br /> P. <br /> 41 <br /> Non xu, <br /> qqp.j'asjgk Iqu)a:lu u <br /> 22 <br /> 011)-;-Ihdd6Kal 221 <br /> RGRA AtItOrRoUveAn, <br /> R6 <br /> RAH <br /> 3,. <br /> di Dw <br /> 'Empty Owm(s) <br /> jjj <br /> aiazardous lest <br /> F <br /> A. <br /> mmLhLol!qiim��of W..Pee ol <br /> feRATE <br /> E NTAP <br /> - l '-10L th-e Gdn ROf-a— <br /> Ry sign,ng this 'd, <br /> ...h <br /> "o <br /> determmetl yof,UiihiabFiJGUiwsl0 o 5AEgr,bb)4h6Or�Al ule as <br /> to meet the Waste Cod <br /> Note:. <br /> dOf9e'W.Lo- <br /> ;Ishipment�9!i P,se 6 11(ffi 6 y.bel t ra-n sp o--rt,e c I i to a-f ....... <br /> � ! <br /> fcomply vn(h federal usedj ; : oi Ufth&tqe.2ptEqqUredto6 ' �11%00eStnngentqegq�� appllmlileto,� ygy� �jpMqqgement <br /> !Rqq -,reqpy,.g� pqe mo --q'5lh5WAWj;?2nit <br /> rrpentss These Indude marP, �ke,.,011,ana ralstqqg <br /> tnngent leak detection <br /> f �—' —,---Tq�, <br /> Ip M"Xen o.n—tr_e <br /> qufd <br /> en s,engineenngdiM %fld <br /> for; Csure!andiccd&bta1;fele 6�j tO! pq,4sppfoijt0.Outjof.6 <br /> I_qm!p"3sjuylayq0MmpHk!O <br /> I <br /> 7" ge en S <br /> dards a_nd not these;more stnngent requirements <br /> This notificahonas liffbfffiatlO77Q—IOnly <br /> 'Law ;D.r....V..d <br /> i Signature <br /> f <br /> ..................... .. <br /> .............. <br /> 7-:,77" <br /> Signatureof Generator,Representative orAgent oGenerator X ` S <br /> f;- <br /> 4, <br /> t <br /> Mle_j,E <br /> '3474 .6 c... ... t d, <br /> -tq <br /> 01"Hagen. nveValley Spdrlgs CA j, <br /> 28 <br /> -dAlIWVR. I q <br /> 209 751-x'600 7 <br /> Z <br /> --- ALOOD21441..17; <br /> �l 00002 7 .......�w t <br /> dy*c, t rn g 'Add ....... <br /> Isposal <br /> ci i es, t: <br /> Rf%o'rK, H ..,H Transfer 5300 — <br /> OS,ERVIMoodial Y <br /> SWO <br /> inVsR(ndqsl <br /> Riverbank•SCA 96367 -:West Sacramento Cp 95691; Ptroiia <br /> t t. <br /> 269.063-8181 :•916371 x5747.. <br /> CAL0000990817' ,'Cppp0g003rS6 EPA Ip <br />