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NON4WMDDUS 1.Generator 10 Number2 Page 1 of 3.Emergency Response Phone 4.W"te Tracfdng Number <br /> WASTE MANIFEST CgX029S7105 ^� 650.331-8013 NNi8061009-i,;:? <br /> S.Generatues Name and MW&v Adman Generator's Silo Addheas M d6erwt than ma"address) <br /> SLIfdA41ERM1.APARTMENT COMMUMTIE3. 1Q09 R{)WN3 ROAD <br /> 3000 EXECUTIVE PARKWAY,SUITE 450 BURUNC3AME,C.{1 96414 <br /> SAM RAMflN,CA 94683 <br /> Getwal '9 Phone. 411429imME17 <br /> S.TtehapoIW I Cw0aw N U.S.EPA ID Number <br /> ZtAAAA- t <br /> 7_Trareportar 2 ComMy Name U.S.EPA ID Number <br /> U.S.EPA ID Number <br /> HILLS IL YMA W05 5 LANE <br /> 707-432-4627 <br /> F s Flrme: <br /> 3.Waste Shlppng Name and DwalIrtfon 10.Cdlfainm li.Total 12 I" <br /> No, Type Duar" wuvoll <br /> 1. NO1114tAZARDOLIS WASTE SOLID(FJUM•FiAYARDOUS SOIL) 1 DT 18 Y <br /> 2 <br /> (a <br /> 3. <br /> 4. <br /> 13.Sp%W <br /> HandM*u ons and Adffwal kdorrmlon <br /> 1)PHLF 9LL.TCT: CATALYST ENVIRTAL <br /> 14.GOERAT01419MRF MIS CLF[EFICATIONr I hereby dadare that the CwWta of dre omelpwi era fully aW O=rw*despibed above by tlw proper 6hippm name,and are does".peduhged, <br /> maftd and lebda*wcarded,and are In sh mVects m proper cmdttlon for mmspott acoci ft to iMbnble irennaborial and rel wd aeons. <br /> Gollawschmes PFWWTyped Name Slpnetrue • Moroh Day Year <br /> a <br /> 15 Mtamtllothal�hfpr erMs Import to U.S, Bport from U.S. Port cd erOv-t: <br /> I'Mnsooder Ditto US.: <br /> ¢ i6 Tran6par6a:Admmviedprwnt of Recelpl of Mitlarrate <br /> Trarepww 1 ft!0dq Name Signature Month Day YBW' <br /> Transpormr 2 Name r 3tgnitWra Mane Day Year <br /> I I <br /> IT DxrWi y <br /> 17a IXxlefwq Indaton Space ❑Q mnm ❑Type ❑R.§&. ❑Partw Reaction ❑No Ilat d. <br /> NtlaforwxeNuhmber: <br /> i 7b,AItmW1e Fwfny(or Generator) U.B.EPA ID Number <br /> Faciity's Phone. `f! <br /> 17c.80-Aka of Ahaw&FAWIty(or Genef*r) //� Month Day Year <br /> ��yFl <br /> '� �4i <br /> o ` �fyfr <br /> 16.DvAna ed Famk Drrrhw or Cpentor:Cer8 cdon of rvo*d maWdWe mywW by ft mandw <br /> PMWMane Month Dry Year <br /> ti • <br /> 169-BLG0 6 10498(Rev.9109) DESIGNATED FACILITY TO GENERATOR <br />