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P%N=.dw <br /> DOUS . ererator ►1unt r 2.Page 1 of &EmvW xy Hesponse Phww 4.Nate O <br /> WASTE MANFE5T CA�C002957105 1 650.331-8013 11H118061009- <br /> 5.Gamralore Name end Ma!Hrtp Ar ftu GerrensWs She Adtsess R d0orunt Oren mirq Odom") I <br /> SLMBRHLL <br /> ARTMENT <br /> 300D D�n VE PARKWAY,SUITE 450 s 1009 RO IC INdE ROAD <br /> CA 94010 ' J <br /> SAN RAMON,CA 9Ma <br /> GerwvWe Phone. <br /> 6.Trereporlar 1 CwM"Nem —U.S.EPA ID Number <br /> Ze <br /> 7.Trereporter 2 Cmlgany fVmre U.S.EPA ID Number <br /> 8��7 lin t U.S.EPA ID Nornber <br /> 367 o H LAM�A <br /> sv .CA galas <br /> 707-432-4627 <br /> F e Plano`__ <br /> 10.Cartlek!ers 12 l'll <br /> 9.Waste 9ttpprg Name and Deerflptlon _ <br /> 11.Tote) <br /> W. Type Ouarudy iLaI <br /> 1. M094 OMOUS WASTES D )1A?ARDOUS SOH_) 1 DT 18 Y2. <br /> - <br /> l <br /> 3. <br /> 4. "� . ims <br /> is P4iL F i a-3 a,d AdAo — <br /> OLL TO' CATALYST ENVIRONMENTAL <br /> 16.GBIERATORIMFFEROR'S CERTlFICATIOIL•I hereby deduce dref the canwb of dm carq!ww=*vm t*ud Warratoly deserted above by the propnr sh4wQ name,arld are daeefed,paaspd, <br /> mediad and Wbabdlpeacwed,and are to PA respects m proper condltbn Itx Transport acca ft bo eppbcdbM irawatiorml and m*wwl Warn " outs. <br /> W9lQlforore Prinlod/iyped Name b? S Sirytahrra Nordh <br /> FRIM-If 5 Ame"", I &i <br /> P���ii ;; -- Day Yew <br /> •�� <br /> 15 Inknui iond Sh!Ixnenfs ❑Impod Oo U.S. E.W from U.S. Pat of enhylexk <br /> Trempotter S>g_rialure(for exacts arty): 00 MAN US.: <br /> ac 18 Thiimpoder Arinoar!edgrr W of Reovipl of lilkw Wa <br /> Tmrrapoder 1 Pdrted(fyped N66 <br /> "��/G', 'fir�� SwarmM-/ Day Year <br /> Trataparw 2 PdmedrlWW Nerro 3tgnaNm Month <br /> Day Yea <br /> IT Dieaeparwy <br /> 17e.Dlsagwq Inft&A Space ❑Ouarlety ❑Type ❑ ❑Parw Re)acdar ❑Fua Re)d. <br /> Akirolect F!aturenco Nrmbar. <br /> 1 Tb.Attame0e Fedly(or Geniarator) U.S.EPA ID Number <br /> Fact s Phone: <br /> 1%Signature of Aroemele Fad!iry((x Gene a6or) Month Dq Yea/ <br /> 4 <br /> �f <br /> o JUN 0 4 2018 <br /> 16.Designated Fa&y Omar or operator Csr9ieelbrt of rnceipf of mood*cvmW by the roe ft ex me -- <br /> Nerve SI re wntl DAY Year <br /> 16"LC-0 6 10498(Rev 9/09) DESIGNATED FACILITY TO GENERATOR <br />