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09/16/2014 09:36 2094655926 ROTO ROOTER PAGE 04/04 <br /> fr 02/24/2004 FJ8:49 2858252359 CITY OF PIANTE A IUcr rA�3" 01 <br /> �Sr Ldk�� CM OF mMT CA WQCP V 0 <br /> Pk SQU C ERTIFI ATION " <br /> M-00 p Rev.3/00 <br /> 1, <br /> PRODUCER OF[JQ111CJ WA!�TE fes' 3 �// <br /> NAME P <br /> PFION _ G '9V <br /> PICK-UP ADDRESS_ I S' r"I�� L��, Ca- 9 �0 <br /> Number street Crty stets Zip <br /> WASTE SOURCE: DOMESTIC WASTEWATER ONLY from (circle one): ptic Tank Portable Toilet <br /> PICK-UQ QAT ,,,,-TIME__?TUU� QUANTITY i--lf2- gals <br /> I certify that this waste was delivered to the hauler named below for legal dispasal at the site IndloatW. <br /> Ve ron 1 u-, l. G-- <br /> printed Name of Owner,occupant or Agent Signgturo of owner,Occ p tor Agent <br /> 2, HAgLER- <br /> J7 _l A <br /> NAME, _ <br /> 1,2Y S <br /> BUSINESS ADORES <br /> Stmie Zi <br /> Number Street CAY P <br /> I certify that the described waste was hauled by me to the disposal fad9ty r1amed below. <br /> Receiving Station Permit No. /� J/ Vehicle license No. L77 <br /> Permit <br /> C - <br /> Printed Name of Hauler Signature Hauler, <br /> 3. RECEIVING VATfON <br /> NAME.AND ADDRESS: City of Manteca WQCF 2450 West Yosemtle Ave. Manteca, 95337 <br /> Zornryrn2i lno Miulor sabov4 dollvurwd the dejcrltaed lkikjdl Wi,-�r tip llrh rlinlnrrnhl f.14ily. ASA lhal,t was <br /> acceptedfrejected(circle one)material under the terms of the Recemrlg Station permit- <br /> , nature of Waste Facility Operator <br /> DATE~ "�`b-14 _TIME IN TIME=OUT NET QUANTITY � gals_ <br /> `" Received Time Sep, 16. 2014 10 : 33AM No. 7056 <br />