Laserfiche WebLink
Pfeeslaprint of Forth Approved.OMB No.20504039 <br /> LMFOM IMMOM 1.GWArdDr 0 MXrft 2Pop ld 3.Bmwm� 4L0�2�° 9 978 FLE <br /> N1A�fEIlORM CJ, fa <br /> ! Qner*N Meme ad MlWM Adt9eee Gsrerabr 6 MAMM Qf al&mt dw mailing a*hm) <br /> ;"IMP" <br /> W5WM M , SSE 104 1177 S CALAVERMT S+ AVE <br /> i SNO, CA B�fT11 �GY, CA,015W4GaraabrY Rom 2094904074 <br /> 8. raspa6er 1 Nemo �.�..�.,a <br /> '1�TM*Pmt■ A ALTO Ou U.S.EPA ID Hurlber <br /> CAROWDIOW <br /> US. <br /> 7T 2 Nada �tIS (,Vv - `�tC <br /> 8 Daslpsfed I-*Name and Sm Address p - U.S.EPA 0)Nw9w <br /> Ytllyla YES LLC <br /> a <br /> r�iris �� ` <br /> Fad Pbona: <br /> ga 9b US.DDT Dv@m"m(irabdrrg Roper Wp*V llama,Haasd duds.ID ltow6w., 18.cmfbk ae <br /> NM 4(lf ) No TYR 11 1 13.V..Codes <br /> am* WUVOL <br /> I 3. <br /> u.l3pecbf termw ad Idamefon nittritber rygq . <br /> r <br /> .�# ; ) <br /> 15. GEMERATDR'SIOF>FH10tCS CB FiCATM:I haeby dacha fat the Inlferis d fde COrbi nand ae fuly aid a=md4 daeag o above by 8s pope'mgft rimae,ad=rmaifled,Padaged, <br /> I'M ad lebebd0ecaded,and are m al perie in proper mordum for passport a-mn1Yp b appirahb kdettretierralerd na9mel <br /> EVoft,l co ft fiot Bre m06 d tie g am -8 mat and I am fre Primary <br /> msiptdlrai ooMorm b fs tedrrs dips ededred EPAAdsrowledgrnert d Carswd. <br /> I aStTy that fs weds mfiYriastiar eteleroart iderrlAed n fo CFR 26221(x)(f I am a mipe grrerrRy generahor)ar(b)(81 em a amel querrlly garaelp)b tme. <br /> t:,eneralorylOfaor a fiYfedrTyp6d Nana Sgnehse <br /> 16. Sh�xoeMs <br /> ❑4nport b U.S. ❑Eupoit from U S Pat damyk& <br /> Tra"Parw*aY-&ra m%onw: — <br /> 17,TiauporbrArJonxieddrtarto(fieoa�tdMldbriab Dab lem*9 U.S.: <br /> TM1 , yped <br /> r Y :o fr y C ry ��r ir��. w-<--w4 I&I <br /> A <br /> lanepala 2 yped Wens -1 <br /> M wM Day Yaw <br /> 1&DleaepetN,y <br /> a <br /> 18x.Dbuaepaq In lip 01 space ❑ t]rsntty ❑TIP- ❑Residua ❑Pa9el Rejectim ❑Ful Pejedim <br /> Irlerrifeet!intoe Number <br /> 18b.AMerrtdee FaAlty(or Gersrabr) US,EPA ID Nrslrbar <br /> i� Fa vft ptarte: <br /> ® 18c ofA &nab Fodkr(or Rbrdh Vbar <br /> 19.Hmmd-ue N0110 RVOlt Mmullu ant MOW Codes(La.,Godes for humdoee wage east ie k dlapoeal.ab Mcycft ) <br /> 1. 2 r <br /> 1. <br /> 20.Deebrtalad Fmft Owns or Opaabr.Ceri6oebm d receipt of h®rdors mebiiefd oovated by the.,m mcWt ed n*d fn hem 18e <br /> Ke <br /> Wiwi Gap <br /> EPA Form 87W22(Rev.12-17) Previous edbom are obsolete_ GENERATOR'S INITIAL COPT( <br />