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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
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EHD - Public
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NON41AMCIOUS 1.Gmorwor ID Number — --�2.Pagc i cl &Emergor,cy Roepomsa Phone e.Waste Traddng Number --- <br /> WASTE NADNFfST GAIT 57106 1 660.331-8013 NH1806100& <br /> 5.UamfaWa Name And Malting Ad&W -- GmefedoYs Sly Address(d dNkre d than rrafilrtg odyeas) -- <br /> SLMERHIL_APARTMHdT COMMUNITIES. 1009 ROWNS ROAD <br /> 3000 E>83M VE PARKWAY,9 M 450 100ELROLLIN CA 9d0i0 <br /> SAN RAMON.CA 94688 <br /> G&nEr'atafePhale. C1t�7_ <br /> 6.Tmrdpator 1 con"Nemo - - UB.EPA 10 Number <br /> 7.Tmnsporter 2 con"Name U.8 EPA ID Number <br /> U.S.EPA ID Nambrr <br /> 3PS POTRERO HLLS LANE <br /> SUMM.CA 94585 <br /> 707-432-4627 <br /> B.IHeste SNppig Name and DeaceVtlon 10.confauare 11.Total 12 tkdt - <br /> 1. il(C7 U WASTES RDOUS 501E r Qum* wave. —— <br /> ) DT <br /> 13 Special flandsnbrsioetions and NdMonel Infunrwmcn <br /> 1)PNLF 8-333 <br /> W.L TC: CATALYST ENVRCNMEN & <br /> 14.G BiERATORVOFFERORS CERTIFICATIOW I hereby de dwo dal Dw Lxwo :a of me cumfgnrnent ero futlyr and aocw%Iely deaumed above by the proper sbgw g name,end are dassded,pa o{pd, <br /> marked and f bakt*caNed,and are In a9 ospecta In proper cartlidon la transport acwWig to appbcebia ai smistiomd and nabord gaornr oyma. <br /> aro-o+oes Prrntedllyped Narre Sigtt3luro Morn Dy Year <br /> W� �� �� - - <br /> 151nrrrtatlonal Shlpr erS LI lmaporl to U.9, F]Export from U.S. Por of entrybmdt_ <br /> Tmwportar Sgnaluro(fo(expaits orly): Dato loav,ng U.S.. __ <br /> Cc 10 Transporter Adtwaiedrllrerx of ReoW of I11daisia <br /> Trdespmler 1 Pdteadffyped Pietrne swab- Month Month YM <br /> 01Mn - <br /> Tra iWder 2 Pd yped Now Honlh Yew <br /> 17.Dfeaeparwy-- - - <br /> 1 TI.Maepafq Indntlon Spare El OantAy ❑Typo ❑Pb ❑Parde f9eled. ❑m woo. <br /> Nkuolest Ralerenca Number <br /> I Th.ARomam Fadlly(or Germnior) U.S.EPA ID Number <br /> Fanws Phone. _ <br /> 17c.Slgost m of Al salt Faolk(a Govt M) Month Day Year <br /> 16.Designated et or Oplralor.Cery'ioafJom of recWV of melmid/cotaed by the mango except as noted In nem 17a - - <br /> Prnted'i)ped t <br /> Month <br /> — I V <br /> 169-BLC-0 6 10498((6"?WN) DESIGNATED FACILITY ib GENERATOR <br />
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