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I R�REPUBLIC NON -HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST SERVICES 15 9 8 4 3 If waste is asbestos waste, complete Sections 1, II, III and IV If waste is NOT asbestos waste, complete Sections 1, 11 and III rZIPMFRATtiR tt,'nn,*mtnr nmmnletes la-rl a. Generator's US A ID Number b. Manifest Document Number G Page 1 of b. Phone: d. Generators N" and Location: Hanna[ Pbwer Caftmia LLC (Formedy Valley Organics) 916 FMWw d Rd f. Phone: Whop. C.A 95258 -1381 e. Generator's Mailing Address: Foulest Power C alifomia LLC {Formerly Valley Otgani 916 Frewatt Rd. Phone: Ls CA 95258 249-982-1381 j If owner of the generating facility differs from the generator, provide: h. Owner's Name: 1.Owner's Phone No.: I J. Waste Profile 4 k. Exp. Date t. Waste Shipping Name and Description m. C talners n. Tatal QUanti o. Unit VJWoi g. O erato°s Name and Title Print No. T 'Operator refers to the company which owns, leases, operates, �ntrols, or supervises the facility being demolished or renovatedi or the demolition or &=14 MiesihemdWOM I I GSNERATOR'S CERTIFICATION: I hereby at the a 1131 , a state law, has been properly described, dassiti and p g in waste is a treatment residue of a previously restr hazy le u c been treated in accordance with therequirements CF n nal is n t hazardous waste as defined by 40 CFR 261 or any applicable er con ' for transportation according to applicable regulations: AND, if nd 'sposal estrlctions. t certify and warrant that the waste ha hazer %-afj as defined !?y 40 CFR 261.; is I GeneratorAuthodzed Agent Name rint Si natureI r. Date fr -rtmAA 42ionoTGc leinnarolnr rnrnnlatce ,� �nrl TrmnennrFor nmmniatac tin -al a. Transporter's Name and Address: whslrr t-.A'YY Q4z v� b. P��honneQp eA o.i US F.PA Nurnber Q, �/ t� L J l a b. Phone: I hereby certify that the above named material has been accepted and to the best of MX knowlegge the foregoing is true and accurate. c. Driver Name Print d. SI nature 1 e. Date III- nFSTINATION (Generator nomnlete Illa-c and Desfinlation Site comDIetes Illd-al a. Disposal FaciTity and Site Address: Forward Landfill 9999 S. Austin Rd b. Mantecei CA 96336 20S 9S2 o.i US F.PA Nurnber d. Discrepancy Indication Space: b. Phone: I hereby certify that the above named material has been accepted and to the best of MX knowlegge the foregoing is true and accurate. e. Spedal HandlingInstructions and Additional Information: e. Name of Authorized entPrint I f. Signature I Date I IV- ASSESTOS /Generator comoletes 1Va-f and Ooerator complete IVa -0 1 a. Operator's frame and Address: I i c. Responsible Agency Name and Address: b. Phone: d. Phone: e. Spedal HandlingInstructions and Additional Information: f. 11 Friable I] Non -Friable ❑ Both % Friable % Non -Friable I OPERATOR'S CERTIFICA710N: I hereby declare that the contents of this consignment are fully and accurately described above) by the proper shipping and are classified, packaged, marked and labetedlpiacarded, and are in all respects in proper condition for transport according td applicable international Iname and national governmental regulations. I g. O erato°s Name and Title Print K. Si nature) i. Date I 'Operator refers to the company which owns, leases, operates, �ntrols, or supervises the facility being demolished or renovatedi or the demolition or renovation operation or both REV 12110 DESTINATION RETURN