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}{pZgppDUS 1.GareratalD Number 2 Pope—Iof 3 Emergency Response Phone 4.NhrEs Tnctln0 Numbct <br /> y <br /> WASTE MANIFEST CAC0029671M 1 650-331-8013 I NHl8061009- r <br /> S.Generabes Name and Ma'"ACdNae Gene afar a Sde Address Y dHter.m uu,n m,Kr,i address) -- <br /> SUh1Mff*iJLLAPARTIAMT COWAUWIES it1O9 ROLUN8 ROAD <br /> 30170 E3�CUTiVE PARKWAY,9tNTE BSO 1009 RO LIN,CA 94010 <br /> SAN RAMON.CA 94588 <br /> Caoneruors Ftx,::. 41�-�:4II t�--- _ <br /> 6.TMMIPdta 1 CompanylYgre_ -- U.S.EPA ID Number - <br /> T fled / _ <br /> 7.TrmmparW2 Company Name UA EPA ID Numbw <br /> 8.Dlqb"bunl M1160ft U.S.EPA ID Number <br /> 3675 PI,pp TRERO 5 LANE <br /> 707-432-4627 <br /> Facthtyqj hone. <br /> g.waste 9tdppng Name and Oesc¢don--— --- 10.Coma s11.Tate! 12 tAd1 <br /> No. Type Quw* WLNd, <br /> 1. ONLf-W�ARD—SUSW-jTES UD(NOLO-HAZARDOUS SOL) 1 DT 18 Y <br /> 3. <br /> 4. <br /> 19.SpoeW fireUrordfona and AfkliMorml Infomrwtlen -- -_ <br /> i)PHaxmng Ir'- i II-333 <br /> BILL TO: CATALYST ENVIRONMENTAL <br /> 14.fi6lERATORTKIFFEMS C6RTiFICATIO W I hereby declare Bret the conlenb of ft coneignmu t N k*arrd acarrately dtvvtbed abave by the propor shippirrp ram,and are dam&&patiaped <br /> ma*W and tebetrxtpdncrnf t,and are In a1 mspecis m proper cor4tion lot transport aecordng to eppiosMe ntmab nal end rt"I d govam Lora. <br /> r-,iilccr'wOBnmis_Prrdud'iypvdName - SlpaUrre Ma* Doy Year <br /> 1 S LrEerrreBo>e ABs ❑IMPad IO U.S. Q Eves t10m U.S. Fort d e+drylatdl: <br /> Tr ortei Sq tu�!°r a�oBs aM: Data Wft U.S.:n <br /> 16 Twupoft Ardnowlsdp w t of Reale!ol Nsiaiafa - <br /> T My 1 PdMedff7.)Namo SOVIU e Moab Day YM <br /> A-1 4jJJJ��, 1 <br /> TrAffioler 2 PftWyped Name Von Y <br /> V.DAonopancy <br /> 17t Uscmliwi y Indcatlon Space ❑WE" ❑Type ❑RK, ❑ParBal R*dion ❑F.1 R*W. <br /> Handed Wctorenca Number <br /> 176.M.ernata Fadkly(or GenaraiM - 110"1ll'VI U.S.EPA ID Number <br /> Facditys Phone: <br /> 17e.Signature of Allemale Facility(or Gerurft) Month Day Year <br /> 18,Dsdgnaled Faaily Gww or Operabr OerSicdon d receipt d n WwWs caered by the raenAeat except as nomd h hem 17a <br /> PrtrtadTyped Name SVMWM — - Month Day Year <br /> 169.OLC-0 5 10496(Rev.Oft) DESIGNATED FACIUTY TO GENERATOR <br />