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NON4IA7ARDOUS 1.Generator lD Number 2.Page 1 of S Emergency Response Phone 4.Blasts Traddng Nnl bsr <br /> WASTE MANIFEST Cr°yC002967105 _� 1 650.331-8013 I PW'1806140s-j p <br /> S.Gemrotoes Noone and"Addrw GwveraWs Me Adders(R dNlurent than maarg address) -� <br /> SUhdAAERHILLAPARTMENT COMMUANTtES. s ROAD <br /> ROLUN <br /> 3D6D BOCUTIVE PAIWWAY,SUITE 450 1009 10091hIC�4JN CA 98010 <br /> SMRAMON.i:A &Ma <br /> Generabafa Pho <br /> 8.TmnspWar 1 Compgtyr Now — — — <br /> U.S.EPA ID Number <br /> KPA C/c ) <br /> 7.Tra apader 2 Company Name U.S.EPA ID Number <br /> 8 U.S.EPA ID Number <br /> ii a,CA O LAW <br /> T07-432-4627 <br /> FadA a I'ftorte: <br /> 8.Waste 9Npp4g Name and Deecriptlai <br /> 10.Cemaklar8 11,Tow 12 Unit <br /> No, Type Quammy WtNd. <br /> 1. N SOL) i DT 18 Y <br /> m <br /> 2. <br /> 3. <br /> 4. <br /> 13 SpecW Nano g Ysk000ns and AdMortsl Womwmen <br /> 1)PHIF 18-333 <br /> 9 LL.TC: CATALYST ENViRDNMENTAL <br /> 14.0BJERAT0Fr&VR ='6 CERTIFICATION:1 hereby dWare Drat the conlrmb of ft comignment are fumy and s=nWy desWW aloove by the proper ship**name,and are daaeied,pedoged, <br /> marked and labeledVecarded,and are At sA respects m proper*wdltlon for banapod s,=diV to sppAraeble vrb,etgrra!and rrdior el erns <br /> Gen s101f Ws Pr loMyped Nam Slgnnture . Monlh Dry Yoer <br /> MUM Df- "We"jele I <br /> 15 hLb9l tloQrw ❑lnpod to U.S. Export from U.S. Fat of arAryletll <br /> frowodef e ds Dills leaft U.S-, <br /> tr 16 Tmmpaae AdmoaaedpnwR of Reoetpt d M tadda <br /> Trampodar 1 PdrbadRAW Nemo Slgnalum lAaft Day Year <br /> Transpar*2 PriMadrfyped Name SlyrwWm Month Day Year <br /> 17.D*wpaney <br /> 1x fYscrepnnctr ln*don Space ❑ y ❑Type ❑mew. ❑Parmal F*vu. ❑WA B*don <br /> Manmad Referwrce Number. <br /> 17b.Mffn N F&Mi (or Generator) U.B.EPA ID Number <br /> Pati"Phone: 4p, <br /> 17e.SoMure of Mn*Fediky(a Gawalor) t� Month Day Yew <br /> z j <br /> I <br /> �D <br /> 18.DesignHod Faaf�ly Omer a Cgeraloc Certicellon of reteilrl d malertals rnrered by the rsanl(est escapt�noted i �/� <br /> ftbdTyped Name Signature Mordh Day Year <br /> 1 <br /> 'es <br /> 169-BLC-0 6 10498(Rev.9M) DESIGNATED FACILITY TO GENERATOR <br />