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_ '?7� <br /> NM4IAW000S 1.Generoror ID 1Jl rrrber 2.Page 1 i Be Phare 4.llfuto Tracing Nwlim <br /> WASTE MAMFEST CAC002967105 1 1 6503318013NH180610091,P1j <br /> S.Gorwator s Name erd MR;Address — GenamW3 Sha Addroso(R dRfathan <br /> erl na ft address) — <br /> SL461AERHAIAPARTMENT COI4WMTrzS. f049 ROLl.8V8 ROAD <br /> 3M EXeCUTIVE PARKWAY,SLATE 450 1009 ROLLIN, R 94010 <br /> SAN RAMON.CA 94683 <br /> Gorw1don Phora 1 i.C4d. i <br /> &Twdparor 1 Compary U.S.EPA ID Number <br /> 7.Tmneporar 2Pe^Y 1Vanre U.S.EPA ID Number <br /> U.S.EPA ID Number <br /> 3675 POTRERO HILLS LANE <br /> SUVA,CA 9r4585 <br /> Feel Vs Plane: *707-432-467 <br /> _ <br /> 9.Mesta Skipping Name and Deacdptlon 10,Corvwners 11.Tow 12 Unit <br /> No. Type Gura* MA01. <br /> i, NONE (NOIY-FIAZRRDOUS SOIL) 1 DT 1$ Y <br /> 4. - - <br /> 19�?PHa n*VF $-333*holons and Addrt*r l Infometm <br /> 9U TO; CATALYST ENVIRONMENTAL <br /> 14.00ERATOR'SIOFF& 'S CERTIFICATIOit•I hereby declare that the oorrLvb of ftcerc?gvnwd are tu:y and acrurawy de-.rrLed ave by the proper otgrerrg name,and are rlaeOiBd,Pmtra94 <br /> marked arxl W*a14>Mv".arded,and are in ed mapeds m proper CorditWn la transport according to sppbmblo xmarxdxmal and twbmvd govern nems. <br /> Gm toe"oroes PoniWVI ped Name Sgrunro • MorrYt Dy Yew <br /> 1) � 00f, S <br /> 15 tote reflonal Shipments — <br /> ❑bupod to U.S. 0 Export from U.S. Port of ermyle#t_ <br /> TnumNner Srwlura r expxbi only): <br /> 1E Transporter ArinorAedgment of Reoegl of Materiels <br /> Transporter 1 PdrtWyped Name - Signature monih Day Y <br /> f . <br /> Transporter 2 PdrdedvTyped Nemo Slprnorro UMth Day Yew <br /> 17.DxreWo <br /> 17a Discrepancy In6caUm Sparc ❑ ❑Type — --❑Residue ❑Plrtlel wow ❑Fu1 P.I.M. <br /> wniosl Referenco Nrmrber. <br /> 17b.AlDernale FwRly(or Generator) U.S.EPA ID Numbst <br /> Fatality's Phone: <br /> 17c.SOmium of kW—*Faday(or Gonaalor) Month Day Yea <br /> ro <br /> 19.Designated Featly Gww or pperaW..Cell kdm of rR>alpt of rr*W ds mtered by the rwtw except as muted in flan 17a <br /> PrntetvT"d Name o Month Day <br /> 16"LC-0 6 10498(Rev.9M) DESIGNATED FACILITY TO GENERATOR <br />