Laserfiche WebLink
Fax Server 8/6/2015 4 :01 :05 PM PAGE 13/04 Fax <br /> RECEIVE) <br /> AUG 06 2015 <br /> Reasapirmor Fonn;desi ned4oruse onsl!le'(12-pitcht,typewdter.) <br /> JI <br /> UNIFORM'HAZARDOUS '1.GeMretorlD N.rtnhIn i2.Pegelaf 3.Emuge !!';i; Iy;phone 4. <br /> WASTE MANffEST C,4, L-0 0 0 -1 7 6 6 II 6 ! t8'rn 81;g:r,•08'' <br /> S.Gena" Name sansta rgAddisas GenerelaCa She Addmss'IRiSRfrentthan <br /> I�&P RdDUSTRES RIC PACTGY P_ACI,AGTIG IPIC ! <br /> DBA PACTN LLC t 119 PERFhRMANCE D5.I{•n+ <br /> 4545 OANT�_c L9NE <br /> Gsnera&sPMne:20''1 483-6014 STOCSTON,CA 95296 STOCKTON.CA 95296 <br /> 6.Transporter 1`Cdnpany Name <br /> VEOLiA w TECITI•I1C US.EPAIDNumba.. <br /> AL SOLUTIONS NI D 0 8 0 <br /> 7,Tmtspoaa2 Compary Name <br /> 5S.._ - -Number <br /> b Number <br /> 8.Desipretad Fac k Naneand Ste <br /> AO�eL.L;C. AESTECHN[CAI.SOLUTIONS, u.s.EPAIDNumDer <br /> GLC. <br /> 1133 HENSLEYSTREET <br /> FROMYSPhons: 660 143-5381 RICHMOND.CA 94801 C <br /> 9a9b.Us.DDToft* nfWuft PapwSNppinName,Had h,, <br /> ° T 9 8 C O 1 g 0 7 9 <br /> FN eMPatldngGfoup6tsny)1 b Nunner, 10.Conunare <br /> 11.70w 12.Unit" 13.Wade Codes <br /> 1. N0. Type fAun6ty WINN. <br /> '!ON-RCRA HAZARDOUS,WASTE SOLID,(MON PCF LIGHT 3i2 <br /> BALLAST) <br /> a <br /> 2. <br /> D F 0 P <br /> W <br /> 3. <br /> 4. <br /> 1a.SpnNaryandipg lnaelmo'onsand a¢Mmrmauon ER SeT.lrice Coata6p9d 6y t7EST <br /> S -!• 1)'t,F:7S9868'A.'SLMI7384P <br /> 75: GEMERATDR's/DFFER0R5 CERTIFICATX)N:IDaehy declare UrefUe mdephd - <br /> makedeMaDeldtlpNgldod�aWmin,llrep"in popefwndtlpn(ah'ans g �lare111,1 gawureMly,de&alh¢E:abova by,the,p!epanaNpp.M9 ranRaNaredaalgptl,psdxgad.. <br /> pml arccrdng b apolcaNe'ahnredoneland rwtionNgovanmelblreladellpna,HexportahlgneM and.l mn Ne Binary <br /> Fxpwlar,I wN1y.NaIIM wnlarenollHS wneigNnaU wnbrmtotheamaatthealhded EPpAdaroxladgmantofCorrsan <br /> lmr*UWtMymlerteranp*orcstdementkimUledh40CFR262:271a)plrem rprgaquannly9a�aa aa(Dl'ltlPaea snigl9ua ramr)Is uua <br /> Gene.& fs'PdnN4rn_ Name SlgnaWre <br /> Dry Year <br /> J 16.IMerrcdblal;6Mpmenls - I. 1„I 7 I 3 <br /> Fz ❑Importb US. ❑Fxpsnicm Us 'Pon of weylox. <br /> irmnsponer algnNme(for exports mm: <br /> TmmpodaAcppa9M Dab laenig�US: <br /> 17. <br /> gment d Remold of Malarals <br /> �',TrantpaMr I an, <br /> O. 1p.�f ., j r,'r' SgnaNre •µ,.,... Month Day Year <br /> 6 Tmnsportac2Pnme ypetl Name � �••� .3. l <br /> r s�nasue Month rDay Year <br /> 16.DlsuapwI:y <br /> 18a.D,sompancy InftW Spee <br /> ❑DuanGy ❑Type ❑ResMue <br /> ❑PaaM'ReJW- ED Fee <br /> Re!ea�n-4 <br /> 16D.AUerrale FatlNry(orGenerata) akNeatid3ferenca ' <br /> � US,EPAIDMI <br /> sa Rally Plmc: <br /> 1&.'Signature orMkmde FenAry(a Generator <br /> Q Manlh 'qy ypr <br /> 'ya. 18.Hazmdoue.Wada ReponMenegameM MBllwd CMx Q.a,wdesfenhmallouspasM.ieaanard,dlposal„aM,regvd0g sydeme) <br /> 0 1. 2' 3• 4. <br /> 20.Deillne Fallty OrmararOpeaapr.Ce ®Uon oheoeipl olh®rdous rreyrietsmsamd Dy rya mardealexseplas wed In llarn iea <br /> Nemo reAra <br /> Mon Day <br /> EPAFM 6709-22(Rev.3.05) Previous editions are obsolete. <br /> GENERATOR'S INITIAL COPY <br />