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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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J�) , <br /> J <br /> NOH4IAZARDOUS I.Gorwrtaorl0 t4lenber 2 Page 1 d 9 Emopncy Reaponee Pham 4.l osw rnddng Nnim — <br /> WASTE MANIFEST CAC002957105 1 6501.331-8013 NHI8061009-0 <br /> S.Genaralvr9 Name end Mem AM= GennroW3 Sm Address( Met"men ma*q addmaa) <br /> SWAMEFOiLLAPARTMENT COM169JNRIES. <br /> 3000 BecuTNE PARKWAY,SUITE 450 1049 ROIIINS ROAD <br /> SAN RAMON.CA 946$3 BURUNGAME,CA 94010 <br /> GmnWs Rvm <br /> 8.Twiporw 1 Name U.S.EPA ID Number <br /> 7.Tmnp W 2 Cdlrperry Nwro <br /> U.S.EPA ID Number <br /> U.S.EPA ID Number <br /> 3675 POTRERO M-LS LAME <br /> SUt".CA W35 <br /> 707-432.4627 <br /> F 's Plwnu: <br /> 9.Waage Stdpprg Name and Deealpdpn 1U. 11.Tool 12 LkA -- <br /> r�, rype wordy wi <br /> I. No US WASTE SOLD(NON FIA�'ARDOUS Sd1L) 1 DT 18 Y <br /> 2. <br /> a. — <br /> a. - <br /> issp PREF loshvkm&3 anti Add�ionm Inrom;allm <br /> 1i TO: CATALYST EMRROWNENTAL <br /> 14.ODIERATORWOMOMIS Mff FtCA7M*I hereby Wolore that the coift. d 1bal conalona Bnt aro tufy and accurately dmtd)ed sbow by Bre proper abom name,acrd an doweled,pad eyed, <br /> marked and Iebeledryliecarded,and are mal mopeds m proper Cordttlon W Ermapod accadir®to appiwbla adertreNaral and raiVd <br /> aw. mr'e Prinlod/lyped Neme 9lpr>nture ��7 NoM Day Year <br /> MUAPS <br /> 16lnknrmbtrel9fiiprrranm fb?, J _-- -- <br /> ti— <br /> Import to U.B. Q apm Iran U.S. Part d cin y/e�l__ <br /> Transporter Stpneture(lor amorts oriy): Do leaaltg U.S.: <br /> 1e Transpmto AdnorAodpnoM d Reaip olNefeft — —— <br /> Trarnpmler 1 Pdrdedri fteme! J <br /> hJ �1 0 YO <br /> TrarLs orter 2 PAroed+iyped Name Blyrrafro elonm Day You <br /> 17.Diaerepancy <br /> Ila rAscipancy Indi Space <br /> Ouentlty ❑7ype U Realdue ❑ParBel Repdiott n Full Aetlrctlon <br /> irkellasl Retai3ncv NurcR��c <br /> 17b.Altervft Faft(orGorwaM U.S.FPA ID N,urber <br /> F9r l's Phora: <br /> y � <br /> 17e.Sajukire of A)6arnele Facility(or Genw.U) /r Mown Day Year <br /> o bey`/,U n <br /> 18-Lae*nafcd Featly Oamer or OparaW:C d receipt d mwwbk panted by the rmnfid179 -- <br /> f?intar9lyped Nnme —— FlOnri <br /> Day year <br /> 189-811-C-0 8 10498(Rev.9109) DESIGNATED FACILITY TO GENERATOR <br />
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