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6tiLZ "N AdO :: L10 'Sl 'aaa auail p;Aiaaa� <br /> CfiTX OF MANI OA.W CF <br /> WASTE HAM <br /> ER'S SOURCE CERTLFTCATION <br /> 1. PRODUCER OF LIQUID WASTE pg � T <br /> NANMI PHONE r <br /> PICT-III ADDRESS <br /> Number freer City State Zip <br /> WASTE SOURCE: DOMES C WASTHWATER ONLY from(cimle one):' Septic Tank Portable Toilet <br /> PICK- � DATE <br /> I certify that this waaste was delivered.to the hauler named below for legal disposal at the site indicated <br /> Priuted1'dame of Owner,O p o Ager Signature of Owl er,Occupant or Ageat <br /> -I <br /> NAME Roto RGoter <br /> BUs»SADD Esser <br /> Number Stmt City State Zip <br /> I cerofy t the described waste was hauled by me to the disposal facility named below. 1 <br /> Rocei Staton Pemmit No, _ Vehicle License No�/ '32s - <br /> T <br /> Prihted Rlk of Hamer <br /> signature nler <br /> e <br /> 3_ BE G STATION <br /> NAME �iTM ADDRESS_ City of Manteca WQCF 2,450 West Yosemite Ave. Manteca,-CA, 95337 <br /> I certify thehauler above delivered the descn-bed liquid waste to this ty, � <br /> idisposal fao>7.i and that it was <br /> aeceptedlaejected(cele one)material under the terms of the Receiving S e=L <br /> Signature of Waste Facffitp Operator <br /> i <br /> DATE TMM IN 3�v <br /> xn+�ovrA W. —NE7 QUAW rr <br /> Rev.02109 g <br /> d tiOti6 '°N WdOS : l LlH 'Sl 'aaa <br />