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�y % REPUBLIC <br />��" SERVICES, INC. <br />NON -HAZARDOUS WASTE MANIFEST <br />GENERATOR INFORMATION <br />CUSTOM ERrolLLING INFORMATION <br />(kfrmuorNenw_ SAFFWAY 0111ingNvoo; ABLEMA1N'rFNANCu <br />AdJruti, 1987 WEST [ lTFI STRFI:T Aadr= 3224 RE01ONAL PARKWAY <br />City; TRACY c ou,,,y, SAN'T'A ROSA c num <br />size, CA VIP, 95376 sna(r. CA /ip 05403 <br />site, i.ncation(Irdiri'crenq: 1987 WEST I ITN STRPEI--TRACY ^ <br />Republic Servicer Expiration Approval Description of Waste Yolome/Weight <br />Date ConNincr Tyne <br />38501012417 CONTAMINATED SOIL -ADC 51CY 11z8/2p 1 1 <br />*A .__L AJJ7.2-_, <br />1 hereby certify that the above doseribcd materials are non -hazardous wastes as deflrwd by 40 CFR 261 or any applicable etelc law. <br />Further, OW the above na rand r4terials are properly clamIfled, dew ibed, packaged, matted raid labaled, and are In proper <br />condition lbr rranspo Cation according to the appiicabk m Department of Traesportatlwr. <br />d o <br />O4ntra40r1Aa'1h9d ed Aaeot N the QBtQ SAivacA <br />TRANSPORTER fNPORMATION <br />Transporter New A lie. t �i�'jaC j- 11r. DOTW v <br />Tramsportet Addren: ��. ,oG�a ; Truck Number. _ —Y <br />Phone Number: r1 pq - S 4-S - rte$ 2-L <br />1 certify no hazardous waste or other ttViatcd substance was knowingly Introduced to the waste while in my custody. The wane <br />transported in this vehicle is the waste Identified above, to the best of my knowlodge. <br />vlffyl le - I <br />N4= of Awhorized Agent Signature Date Delivered <br />DISPOSAL SITE INFORMATION <br />61k Namo, VASCO ROAD LANDFILL Phone No, 925 447 0491 <br />Site A&IMM 4001 VASCO ROAD LIVERMORE CA <br />I hereby acknowledge receipt of the above described materials. <br />Name (Print or Type) <br />Signature <br />L/L d SL555�520L « t9£LitWOL <br />Date Received <br />9960 9L-'60 £L-90-OLOZ <br />