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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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NON402ARDOUS 1.Gemmtor ID Mmber 2 Page 1 of 3 Em"arry Reepons RON 4.arae.Traoldng Nadw <br /> WASTE 61Art1 GAt 002961105 1 650.331-8013 NH18061009-/7 <br /> S.GeneraWa Name and fdalag Ad*ftmu — tierterafab Sbe Address(A Oglemtl gan ma"aMms9)SLIMMEl'biL - <br /> LAPARTWENT COUMUNITM. 1004 ROWN9 ROAD <br /> E)EXXMVE PARKWAY,DOTE 450 1.CA 940i0 <br /> SAN RAMON.CA 94688 <br /> Generaws ph". <br /> S.Tmnportw 1 CDapany Nara U.S.EPA ID Number <br /> 7.TmrepMer 2 Company Nate UA EPA ID Number <br /> Q D"-"IMMNIV NV6� U.&EPA ID Nanbar <br /> FRO HLLS�a1Nu�15 AV,C'A Was LANE <br /> 707-432.4E27 <br /> FacifrP'e Phone: <br /> D.We"9hlppxg None and Deacdpfbn -- - - - 10.Cmtakers 11.Tow 12 Unit -----, <br /> No, Type Quem* WtNol. <br /> 1• N (N�1-FiJ4ZRRDOLaS SdfL) 1 DT 18 Y <br /> 2. --- - - - <br /> 40 <br /> 4. - <br /> 8-333 <br /> Iagrudfona end Addi6umJ In)errr�lon — - <br /> 19LL Ta: CATALYST ENVIRONMENT& <br /> 14.GMERATORTWOFFUM'S CERTIFICA'nON•I hw*dor' that the as*xb d dm oorefgrtmertt are tiny and aomndSly dm4 bed drove by the proper shilprtg name.and aro dusted,pemlrapeQ <br /> ffwrW and iebefed fled,and are In as mapa is in papa cmdltrnn for trensW s mxft to Wpioeble mu alio W ad relorel 9-wn auras. <br /> Gcneo&smemes PrmIMJT)ped(fame �j 3igrehua • Nonlh Dry Yaw <br /> Eb mlwfs f:b?, mat/ n <br /> 15 InteumdonW Shiments ❑Impcd to U.S. L,J EVW from U.S. Pat o1 in Yh dt <br /> Treroponer svimium rV sAPDrte of*): pale brt"U.S.: <br /> 18.Tren qt Adurmgdpnatt of Reoslpt d Mdaiab - <br /> Tmnporlw t Prl(ied )"d Narre - - - -- - --- 31grrWre - fAofttll Day Yew <br /> r- 4 A R P 0.F _T - / N c." I 1�� •6 ti ! is <br /> w <br /> Transpar 2 P&iWyW Nemo _ gy fraW�e T` -- Me* DW Yew <br /> 17.Dieaepancy <br /> 17a asmVwxT Ird.cason spars Qtratey ❑Type ❑P.W. ❑P.m poo m ❑Rg Neem. <br /> MaMecl Reform Number. <br /> 170.Abwmde Fecfily W Genembt) U.S,EPA ID Number <br /> UANffOU/NONf7 _ <br /> Facdy's Phone. <br /> 17r-S gnakm of Alfie Fs k(or Get v*r) /� Month Day Year <br /> J O <br /> bb <br /> GYp <br /> 18.Designated F90*0ww of Opsralor:Owlinton of recap)d malar ds oOmW by Me fwNW except as noted mlleq l7a <br /> PdnterYfyped Name Slg alure Month Day Yoar <br /> 1MBLC-0 6 10498(Rev.9109) DESIGNATED FACILITY TO GENERATOR <br />
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