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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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NON-HAZARDOUS t.Garararor 10 Number 2 Page 1 of S.Emergency Response Phone4.Waaba incline NwrAw -- — <br /> WASTE MANIFEST CACDO2957105 1 1650-331-8013 NH16M100-9 L <br /> 5.Otneratofe Nerve and MON Address --— GeneraWs She Address(R dllarerrl than nm*g address) <br /> SU MERMLL APARTMMT COMMUNITIES. 00OLLWS ROAD <br /> 14 R <br /> 3000 EMKXTiVE PARKWAY,9LA E 450 i1 M9 R QAME,CA 94010 <br /> SAN RAMM.CA 94583 <br /> Ganuators Phar. <br /> 5,Twdpoft 1 /, U.S.EPA ID Number <br /> 7.Trasporter2 t;porpeny N 4 U.S.EPA ID Number <br /> U.S.EPA ID Nomlwr <br /> 3675 POTRERO HILLS LANE <br /> SUSM,CA 84585 <br /> 707-482-4627 <br /> r-crani,,rfiDcr.. <br /> 10.Contam ra 11.Tow <br /> 8.Waste SNppq Name and Dewtdon <br /> 12 lkdt <br /> _ No, Type Quamdy WLNd, <br /> t, N TES SOIL) 1 DT 18 Y <br /> W <br /> 3. <br /> 4. <br /> 19.SW HandkV$lastrtel uolfons and AdMoInfom aloe -- — <br /> )PHLF <br /> ML TOr CATALYST EWROMENTAL <br /> 14.GENERATOW&II)Fr ROR'S CklInFICATiON•I hereby dxUra thea the corNente d mis cnt�irnnr�ri a lu!y sd"T,,:n4�ly descnbed above by the p aeon eh pprng name,and are ciasaiad pedraeed, <br /> r arkod and fabehl4gamrded,and are in al respods m proper cwdluon Ior Uancpoft accordng to aFpf,"attornetranal and naharutl govanm 1 IDICau. <br /> G a10Remes Prtntod/I'yped Name Styruioro . ' • � Marts Dy Yaw <br /> fbf sv s-. <br /> 15 Nr mean!9*n" ❑i to U.S. __ <br /> �i ❑E�OrI Nom U.S. Port of enlrylenl: <br /> Tracer§Nn t m(for amoda a": _DO WSWKm U.S.: <br /> m 10 Transporter Aduuavle wmt of Raow d mala wo <br /> Trararpuft 1 M14 pay <br /> Tmn6MrbK2 PMWyWName tddrnth Day Yee <br /> 17.Nomparcy <br /> Ila DismTancy Ind icadon Space ❑ Y ❑Type ❑Rttsldrre ❑Pam Re)eo. ❑Fw Nod. <br /> Marines Rcfommb Number, <br /> 17b.AOanato F"y(a Garlarator) U.&EPA ID Number <br /> Fa*ys Phone: <br /> 17c.SiT"re of Allam FaUllq(or Gone,ior) Month Day Year <br /> y <br /> FFell" <br /> 19.-Dv4anted Faahy Ovwr or Opar&W Cof slim of ra*1 of nwilerW5 Dorared by excep pWd in Item i}�y— <br /> PrintedrTyped Noma �v ry,✓ --� \ - --- Mmlh Day You 1I <br /> 165dsLC-0 a 10498(Rev.WN) 1 ��', DESIGNATED FACILITY TO GENERATOR <br />
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