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NON-HAZARDOUS WASTE MANIFEST <br /> Please r•'=w or Cirx- ;F, ::iji •:I for elite(12 plrcn)typewriter] <br /> NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest 2_Page 1 <br /> CAC 0 0 2 9 9 1 4 9 U Document Nn 9 6 2 of 1 <br /> WASTE MANIFEST L <br /> 3.Generator's Name and Mailing Address <br /> CITY«COUNTY OF SAN FRANCISCO <br /> 1390 MARKET ST,SUITE 210 <br /> 4.Gane`rRAi'PS91 5 713-1380 `'A 94102 <br /> 5 Trrlsp,,j L aj f��ne,, r r r 6. U EPA Ip ule� A State Transporter's ID <br /> ,%v vrt_ MONONNIENTA�SERvIC€S C A I� 0 1 1 , 70 -06 <br /> B.Transporter 1 Phone 310 886-3400 <br /> 7 Transporter 2 Company Name 6. US EPA ID Number C.State Transporter's ID <br /> D.Transporter Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> P^OTR€RO HILLS LANDFILL <br /> 3675 PO T RERO HILLS LANE F.Faclilt•s Phone <br /> SUISUN CITY CA 94585 CAR 0 0 0 0 8 9 4 6 6 799 432-4627 <br /> 11.WASTE DESCRIPTION 12. Containers 13, 14, <br /> Total Unit <br /> No. Type Quantity Wt.Nol. <br /> a <br /> NON HAZARDOUS WASTE,WATER 0 Ot T T <br /> G b <br /> E <br /> N <br /> E <br /> R a <br /> A <br /> T <br /> 0 <br /> R d. <br /> W <br /> H <br /> N <br /> aG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> 5 WOES TERMINAL DIXON 11A)NH POTRERO <br /> +�- }Q <br /> O <br /> 0 <br /> a <br /> N <br /> 18.Special Handling Instructions and Additional Information <br /> = EMERGENCY CONTACT:CHEMTREC 1-8004249300 USE PPE <br /> Z SITE: 9000 W VERNALIS RD,TRACY, CA 95377 <br /> O, <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify tiiat the contents of this shipment are tufty and accurorely descrlbed and are In all respects <br /> In proper condition for transport.The materlals described on this manlfosl are not subject to fadafal and nws a hazardous waste regulation,. <br /> Dale <br /> Perrye6 Name Signature Month Day Year <br /> Jl�3�iA, :;66c� 12 l 2 112, <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A Printed/Typed Namen Month Day Year <br /> "S iUW�Y W ill L LLL 12 12 14� <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> O P 9 p <br /> R Printedffyped Name9 Y <br /> Si nature Month Da Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space . <br /> IF <br /> A <br /> C <br /> 1 20 Facility Owner or Opa-rrCJ1:Cof receipt of the waste materials covered by this manifest,cx::epinoted in item 19 <br /> L D o <br /> I <br /> T Printed/Typed NameSignature tlf a V <br /> Y <br />