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-.1-RANSPOKT FORM. #E: ? J <br /> NON-BAZARIDOUS 'WATER TRANSPORT FORMT <br /> GENERATOR INFORMATION <br /> NAME: Ruiz Marko Att:Maws Nebanck <br /> ADDRESS: 4491 Du bam fcM Rd. <br /> CITY,STATE,=- jEa,CA PHONE#, 209,"435-7554 <br /> DMCR1MON OF WATM:MONCIIIR M W$a.CiR6WUR'AY£R IMPAC[73i]WTI'H ffyM0C kRMM FROM A L=STIR <br /> 1 C.FR TPY 71(AT T=MA7%RML IS A 1-1QUD.K=wMT FROM RCRA PER*6 CPR 261.4 MXIV9 AND DOSS <br /> .4 7 MMT TM CRTEMA 071 HA7ARD0U8 MATJR AS TIILSCPXMn W 22 UM AXTP=11 d71 AM QTMM APPUC.AXIZ <br /> SYA_m LAW,7•TA$BBkw ALX ITF MA & <br /> FA[.lf.1OGb Atm fr"iN Pmap G�L7dP h72 <br /> TRANSPOtTA770N ACDOROD4G TO APPU <br /> GENFRATQR/AUTHORIZED AGENT' DATE � <br /> SITE INFORMATION <br /> Site Adds Crass <br /> Rlliz Market 4491 Durham EcM Rd.,Tracy, CA <br /> TOTA]C.CALLONS: <br /> TRANSPORTER INFORMATION <br /> NAiti C1earwatcr EnviroTlmcntal.Nl Imt Att: Dave 2 d <br /> ADDRESS: R.O.Box 7420 <br /> CITY,STATE,Z11?: Fremo t. CA 94557-7420 510-797-SMI <br /> TRUCK ID 9: 110 — Hi <br /> Crypod or printed ftW name&signature) (Date) <br /> RECETvING F.ACILTTY <br /> NAh�IE_ Se=ort Em-Lr=meatal <br /> ADDRESS: 675_Seaport Blut'1, <br /> CrE Y,STATF-. IP: Redwood City.CA 94063---- - PHONE 4: {415)364-.8154 <br /> APPROVAL it: 512-320 <br /> (Typed or printed fu11 name 8s signatum) / - (Dale) <br /> 12/2'.!/�J5 1 : l '1'X/E1X NO.O i'97 P.00:3 <br />