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CO0047142
Environmental Health - Public
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2200 - Hazardous Waste Program
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CO0047142
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Entry Properties
Last modified
9/14/2020 6:28:05 PM
Creation date
9/14/2020 9:19:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
RECORD_ID
CO0047142
PE
2200
STREET_NUMBER
23523
Direction
S
STREET_NAME
BANTA
STREET_TYPE
RD
City
TRACY
Zip
95304
APN
25013009
ENTERED_DATE
7/24/2018 12:00:00 AM
SITE_LOCATION
23523 S BANTA RD
RECEIVED_DATE
7/23/2018 12:00:00 AM
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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ADMIN
Tags
EHD - Public
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NON4LUMDDU5 T•Generator TD Nunhe - - 2.Page 1 of s Emergmwy Response Phone 4.1 1 Tm*ng fftdm _ <br /> YfASTE IIAMFE6T CPAC002957105 1 66D•3314013 1dH18D61009-,f ' <br /> S.Deneratola Nerve uw McBirg Adm9ss — -- Generalds Sk Address(R drawl Mean rmlrp 0d 03) <br /> SLNAAERHRLAPARTMENT CC&AA JNTIES. R <br /> 1049 OWAIS ROAD <br /> 30dD E!'� unvE PARKWAY,9U1TE 490 1009 OLLW,CA 94010 <br /> SAN RAMON.CA 94683 <br /> Genarator's Phow <br /> e.Transporter 1 ConpsnyNeme U.B.EPA ID Number <br /> 7.Tnr"OrW 2 y Nam 4�u�. U.S.EPA ID Number <br /> B�eJ P1n CtilUDf - U.S.EPA ID NIWw <br /> BU ��5$HLLS S LANE <br /> 707.432-4W <br /> Fad a ffio,w: <br /> 10.Cerrfaklars <br /> 8.Waste 9Nppirrg Name and DeaabUon 11.TOW 12 Unit <br /> — <br /> No. Type Duarddy W1JYd, <br /> 1. OEF+1 QUS (W�1-FIAZAROIdII�S41L) 1 [7T 18 Y --- <br /> 2 -- -- ---- -- ---- -- <br /> 4, <br /> is.Spec' rt p� l and Addlonr inkxrrk3Ym - - — <br /> na <br /> N.L Tart CATALYST ENVRUNMEfVTAL <br /> 14.Ofik"ATDR'tK7RUM'S CERTIFICATION-I hereby declare Mat The conR3rts of 0115 cor�ignm m ere fully and accuratoly de%rd.,ed aimye by The prcpof shipprrg came,adwedawfled,peckspad <br /> marked arrd labeiadObwded,and arc to aA ra4wds Al proper condium for hanspod accordrg to appbcable wdwwtcnw".6.rel carne. <br /> Oerrr orafORa+ore PrimoMyped N,vne �� 8ig ww Noah Doy Yar <br /> (►`YcFRIUAfs- fvu&;t�� <br /> to tntemeMoneiftvwm ❑Import to U.S. ❑Evort from us port of wtyk* <br /> Trarmlyrter Signature e <br /> ir 18 Tn mpod r Admoniedgriwe of Reosipt of Nfltrlels <br /> T ' --- M Y <br /> T ftr2 P~yWNerm / Month Day Year <br /> t7.[aeaeparwy - <br /> l7a Discrepmxy In*dm Space ❑Dwtty ❑Type ❑Rasldue r_ Pa tlel Ra*sm ❑Fes Il*W. <br /> Wnrfesl f1domow Number. <br /> 17b.Afternalo Fedk(or Genaator) --- U.S.EPA ID Number <br /> r+. Ftitii9,ys Phone: <br /> 170 S gnawre of Afternele Fadlily(a Ganerssor) Marts Day You <br /> a <br /> 18.Oes gnabd Faatxy Owner or OpasW.Carti6caW of mc*of mWod*cmeed byte mmtRest expo w noted n T7a <br /> F'rintaf Amd Name _ month <br /> 169-BLC-0 6 10498(Rev.9M) DF.SIQ A'J EM FACILITY TO GENERATOR <br />
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