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NON-HAZARDOUS P1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.Waste T19-1603 1 WASTE MANIFEST NIA 1 (877)256-8265 Generator's Site Address(if different than mailing address) 5.Generators Name and Mailing Address AG2 Transport 16850 W.Byron Rd 2315 Meredith Ln ISA TraCy,CA 95304 Santa Maria.CA 93455 � Generator's Phone: 14-2722 U.S.EPA ID Number 6.Transporter 1 Company Name CAROOOI S0737 Ponder Environmental Services Inc U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8,Designated Facility Name and Site Address Potrero Hits Landfill 3075 Potrero Hils Ln Suisun City,CA 94585 Facili 's Phone: 4324827 10.Containers 11.Total 12.Unit 9,Waste Shipping Name and Description No Type Quantity Wt./Vol1. . o Non-lina�Wade, Solid(soil absorbent 03 DM 800 P a contaminated W&I U11`00) W 2 2. W 3. 4. 13.Special Handling Instructions and Additional Information i r i) M9 I J Praft M*LF-19-032 PO#742855 Job#19-16030 14.GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name.and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. Month Day Year GeneratoeslOfferor's Printe VTyped Name Signature Anderson on behalf of AG2 Trans ort k 101 114 J 15.International Shipments D Import to U.S. ❑Export from U Port of entrylexit: iz.. Date leavin U.S.: Trans er Si nature for exports only): cc 16.Transporter Acknowledgment of Receipt of Materials Month Day Year Trans rff1P'nted/TypedNam Signaturecc per, Month Day Year Transporter 2 Printedrryped Name Sign re 17.Discrepancy El Residue ❑Partial Rejection ❑Full Rejection 17a Discrepancy Indication Space ❑Quantity ❑Type Manifest Reference Number: U.S.EPA ID Number > 17b.Alternate Facility(or Generator) U Facility's Phone: Month Day Year 17c.Signature of Alternate Facility(or Generator) Z On U) W 18.Designated Facility Owner or perato a ication of receipt of materials covered by the manifest except as noted i 17a onth Printed/Typed Name Signature DESIGNATED FACILITY TO NE TOF 169-BLC-0 6 10498(Rev. / 9)