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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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NON4W_ARDDUS 1.Generates ID Number 2 Page 1 d &Emergency Response Phone 4.Waste Traddng dumber <br /> WASTE MARFEST CAC0029671D5 1 650-331-8013 NH18061009- <br /> 5.Gwaratora Name and M&''*V Ar d w GerraoWs She Address <br /> SUWAERMILL APARTMENT COMMUNITIES. <br /> 3000 EXECUTIVE PARKWAY,SUITE 450 1009 RQLLWS ROAD <br /> SAN RAMOA.CA 94588 BURLJNGGAME,GA 94010 <br /> Ge:11ways Phone. A15-22&01177 I <br /> a.Tlorreporter l Conor Narne 1 LLS EPA ID Number <br /> 1 �r� V kA 1✓C <br /> 7-TrarrpaEsr 2 Company Name LLS EPA ID Number <br /> p��ss,l i <br /> 8.D�( 4V n1L U.S.EPA ID Nomber <br /> 3675 POTRERO HILLS LANE <br /> SUISUN,CA 84585 <br /> 707-432.4627 <br /> F " 's ifiorm: <br /> 10.Containae11.Total 12 Unit <br /> B.Walla Skipping Name and Description <br /> No, Type Guatldy WtJVd, <br /> 1. INaN-F1A7JW7�STE 5��(�fC -DOUS 501L) 1 DT 18 Y <br /> I <br /> i <br /> W2 --- - -- - - - - - - - — -- — i <br /> <D <br /> s' <br /> i <br /> 4. <br /> 19�c���ie�ndlnp�WatucUons and Additional IntartnuYon <br /> 3,33 <br /> INLL.TO: CATALYST ENVIRONMENTAL <br /> 14.00E7IATOR'81014%M'S MIMFICATIDN•I hereby Cedars that the wftlts d frra consivvi ant am lolly and acantely des AW shove by the proper O ppmg name,anti are dassied,per�ged, <br /> madwd and iabeled*carded,and are In sX mapscts m proper cordidon la transport accadng to appic"cnsratimrsl rrrd ndla�govermovo rrsg&lons. <br /> a0broea PriMwffyped Name - - --- Signature - -y.--� Non1, Day Year <br /> Neu MuAfs F i? SU <br /> 15 h,Yxnetlo tel Stdpma its <br /> ❑IlrPoA t0 U.S. �Fapat from U.S. Port a1 enlryJext_ <br /> T r S' re suds only): Date leevkp U.S.: <br /> err id T•;r;rart=r AdalowYMgmcM 01 Receipt d Melaiela � _— - ----- <br /> Tranweler 1 Pdnhadr'1'yw Name Signature ► Matfi Day Yw <br /> Tranapow 2 PdrrtaYfyyad Name $IprWfe Momh Day Yea <br /> 17.Dkgmncy ff--11 <br /> Ila ascrepar,cy Indaeon space ❑ ElTypes ElReddue U Pallial mow. L7 m P4.dan <br /> hku&rA Rclomow NurnWr. <br /> 17b.Atiemato Facility(or Generator) U.S.EPA ID Number <br /> Faiilily's Phone: _ rj <br /> 17c.Signature of Altamele tidily(or Gonealor) //p7 Month Day Year <br /> JuAl <br /> 18.Dasigneted FsoiAy Oanar a Oprrala:Carh'icaibn oI nace;pt d melmtda cased b7 the rea,Aeat eacept as Ian (y <br /> Prhted rxd New, Stg>atu -- Montr Day Year <br /> 1694LC-0 6 10498(Rev.W09) DESIGNATED FACILITY TO GENERATOR <br />
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