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ZtiLZ 'oN WdOti l LINSl 'aaQ awil pzniaazd'� <br /> OF MANTECA,MLQCF <br /> WA TE HALMER'S S0j CE CERT CATION <br /> 1. <br /> PRODUCER OFA.IUM WASTE pg T <br /> NAME, - PHONE 0 <br /> III ADDss L.A41 <br /> Number Street City State zip :I <br /> WAS III SODRCE: D ME5- C W,AST'fi�ATEtt ONZy from(cycle one): Septic Tank portable Toilet ' <br /> PICK UIP DATE l� / TIlVUB2—5�_ e^'L QUANT= <br /> I certify IdIat this waste was delivered to the hauler named below for legal disposal at the sito indicated. <br /> I�f�1�1,.c 1 • � o� r� � <br /> pr�n blame of Owner,Occapt <br /> or eut a of cupant or.Agent <br /> I <br /> 2. SAS i <br /> NAME R,,,tr <br /> BUSINESS ADDRESS Lj h ti 4 �_�� CM <br /> Number Street City State zip <br /> I certify the dwcn"bed waste was hauled by me to the disposal fue77ity named below. <br /> Rcceivin <br /> g Station Permit No_ VGmell e Li c No_ <br /> n� p <br /> Pnouted I mre o Hamer Signature of <br /> 7j- <br /> 3- G SWATION <br /> I�TAMEADDRESS; City of Manteca WQCT 2,450 Nest Yosemite Ave. Maateua,•CA 95337 <br /> AND <br /> I certify that theer above delivered the described li d waste to this b <br /> accepted/'° jected(circle ogle)m MrW under the terms of the Receiving Std pe nit��and that it was <br /> - i <br /> S' tare of Waste Fu 'ty Opmtor <br /> DATE TIl OUT NET Q1U'AN'TITY <br /> Rem,OZ/09 0ffi � <br /> ti 'd tiOti6 '°N WdOS : l LlOZ 'Sl 'aaQ <br />