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N014 AZARDOU3 1.GeneruW10 Number 2.Page 1 of 3.Emergenq Response Ptrone 4.Wute Tr=Wng Number <br /> WASTE(MANIFEST CAC00290105 _—�-—t 660»331-8013 I NH18061009--):y <br /> S.GmeraWa Name wW Mal"Address — Gereralor's 1-3%Addrass(H dlfe(ttrrt Vw miAng addiess) <br /> SL Hfl_LAPARTMENT COWAUMTIES.AM ROAD <br /> S IROLR <br /> 1009 ROLA <br /> 3Q00 Emecu VE PAI'tKwAY,SLATE 460 009 R 9d0i0 <br /> SRAMON.CA 94888 <br /> Gwwwoe&Fiw .w. <br /> 6.Tmmporta 1 CmrVBW Now n — u /1/1 f U.S.EPA ID Number <br /> 7.Trereparw 2 Catpeny Name U.S.EPA ID Numbef <br /> e-D.054 I*f6ftgL4 Dift_ U.S.EPA ID Number <br /> XTS POTROW HILLS LANE <br /> SU".CA W85 <br /> 707-432-4627 <br /> Fediaf''c ffiana; <br /> 8.Wavle ShpOng Mame and Deecroon 1 a.Cmta ne s 11.Totes 12 Unit <br /> No. Type Quantity WtJVOL <br /> I. NO S (i40MlF S01L) 1 CYT 1$ 'y <br /> m <br /> 2. <br /> L7 <br /> 3. <br /> 4. <br /> 13 Sp"W <br /> Hu F T$Wtud-uom and AdM6rW In amilon <br /> i)PHBILL.TO. CATALYST ENVIRONMENTAL <br /> 14.GENERATORI OFFEROR'S CEIMFICATION:I hereby dedare that the coownts of Om wrolgunant are fitly and scarrately dearathed above by do prcpof shipping carne,and are daaeded,pedreged, <br /> nrarW and labela91p1armded,and are in 0 respesdsU05 ,inn�pjro�per coWdon la trimpad cccordng to oppkaabk k&wo trunal and neYwW eons. <br /> Gcroe alOtferora Printc+dRyped Nam �� �V 9lprrdUra • f� Ij( �Y <br /> p t-���1 <br /> 15 Inperrradontd wwords ❑Impod to U.B. ❑Exvm fm U.S. Fe o1 erdryk* <br /> Trempoder Swubm ft Do*baft U.S.: <br /> w 16 Tmntpxw AdmowW7r w6 of Receipt of Mm*tals <br /> Trampoder 1 Pritdi MyMd Narra Slgrnture Month fay Y <br /> Traisporter 2 PdrdedrTyped Name $Ig 0fe M6,131 Day Ye if <br /> 17.DWmuparw.y <br /> Ila 01screpwwy Irrdcaaon Space LJ f I— Qm ❑Typ ❑Rwid. F1 Pm ReJeraian ❑Fuq Relecaon <br /> �rdlest FlMerrr,.o t�ixnt�r. <br /> t7b,Ahlemato Fad*(or Generator) U.S.EPA ID Nurnbor <br /> W Fac-Ws Plane: <br /> 170.5ignalrre of Alfentele Fadlq(or Gene'7tor) Abn1A Dey Year <br /> 18,Onignaled Faolrly Owner or Operator:Certicatlon of receipt of maledale cvmri d by ase Apndest a road in I 17a <br /> Prhf dFfflW Nemo y Wxth Bary Yaar <br /> �J <br /> 169-BL"6 10498(Rev.BM) � DESIGNATED FAOILffV PO GENERATOR <br /> s�, <br />