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POTRERO HILLS LANDFILL <br /> A Waste Connections Company SCALE TAG#© y c7 2)•I'IS 541 <br /> NON—HAZARDOUS WASTE MANIFEST <br /> GENERATOR INFORMATION CUSTOMER/BILLING INFORMATION <br /> Generator Name: CAR ENTERPRISES Billing Name: ADVANCED ENVIRONMENTAL SVCS. <br /> Address: 1040 NORTH BENSONAVENUE Address: PO BOX 593 <br /> SAN <br /> City: UPLAND County: BERNARDINO City: CORTA MADERA County: MARIN <br /> State: CA Zip: 91786 State: CA Zip: 94976 <br /> Site Location(if different): e j LtJ, , e Get l�s <br /> Approval# Description of Waste Volume/Weight Expiration <br /> Container Type <br /> te <br /> PHLF17280 NON-HAZARDOUS LI UID TONS 04/03/2018 <br /> *Attach Additional Sheet if necessary <br /> I hereby certify that the above-described materials are non-hazardous wastes as defined by 40 CFR 261 or any applicable state law. Further,that <br /> the above named materials are properly classified,described,packaged,marked and labeled,and are in proper condition for transportation <br /> according to the applicable regulations of the Department of T <br /> �t.'1 A''�r i'11.\'� ,��..11 \ 7,� ' rllku QA)(-y,P <br /> Generator/Authorized Agent Name Si <br /> Date Shipped <br /> TRANSPORTER INFORMATION > <br /> Transporter Name: LD LLC_ License Plate# <br /> Transporter Address: Z 0 OUINIA1 . Truck Number: <br /> Phone Number. 1.%i V`i<= G 9 <br /> I certify no hazardous waste or other regulated substance was knowingly introduced to the waste while in my custody. The waste transported in <br /> this vehicle is the waste identified above,to the best of my knowledge. <br /> Driver/Authorized Agent Name(Print First,Last Name) Signature J Date Delivered <br /> "DISPOSAL SITE INFORMATION" <br /> Site Name: POTRERO HILLS LANDFILL,INC. 'd410 ea SUAVE9$ e <br /> Site AddrbWHA Sgt LLS LANE SUISUN,CA 94585 Truck Wei <br /> I hereby acknowledge rec�ipr pf �al�vK escribed materials. 6' ! 'y%' QFC <br /> 11[[JJ1ltltl �� (((U)I( -5m1Enn������t,,Naf;t :;, — 12 2017 <br /> Own HILU IAIII�IIL,INC. l1R <br /> nA <br /> Weigh Master Name(Print or Type) ivvA Al. <br /> Signaturer <br /> oFpgF?7-A4 T <br />