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Non-Hazardous Waste Manifest <br />_ . . .. . <br />' GENERATOR SECTION <br />Non-Hazardous Waste Manifest Generator ID Number Waste Profile Number <br />PHLF-20-625 <br />Waste Tracking (Manifest) Number <br />400-13-28022 <br />Customer Billing Name and Mailing <br />ANCON <br />570 Business Park Drive, Suite 110, Lincoln, CA 95648 <br />Customer Billing Phone (916) 917-6328 <br />Generator's Site Address <br />JB Hunt: Arch Road and Logistics Drive <br />Stockton, CA 95215 <br />Generator's Phone: (479) 820-0000 <br />Transporters Company Name <br />ANCON <br />US EPA ID Number <br />CAD980737068 <br />Transporter 2 Company Name US EPA ID Number <br />Designated Facility Name and Site Address <br />Potrero Hills Landfill, Inc. <br />3675 Potrero Hills Lane, Suisun, CA 94585 <br />Facility's Phone: (707) 432-4627 <br />US EPA ID Number <br />Waste Shipping Name and Description <br />Containers <br />No. Type <br />Total Quantity Unit Wt/ Vol Disposal Method <br />1 Non-Hazardous Water 1 TT ViSo a . & 0 G H132 <br />2 <br />3 <br />4 <br />Special Handling Instructions and Additional information <br />Wear appropriate PPE when handling. Job #400-13-28022 <br />24 Hour Emergency Response <br />800-556-9090 <br />Phone <br />Emergency Response Guide Number <br />GENERATOR'S / OFFEROR'S CERTIFICATION:I hereby certify that the above-described materials are non-hazardous wastes as defined by 40 CFR 261 or any appli able state law. Further, that <br />materials are properly classitled, described, packaged, marked and labeled, and are in proper condition for transportation according to the applicable regulations o the Department of Transportation <br />the above named <br />Generator's Offeror's Printed / Typed Name <br />C '- <br />) '''' Ill <br />‘":57 <br />Signature <br />--, -7 <br />. Ir <br />Month <br />..'11I) <br />Day Year <br />TRANSPORTER SECTION <br />, ! <br />Transporters Acknowledgement of Receipt of Materials <br />Transporter I NI I tied /(Typed(Name <br />t.L.C, 1,•'/ / 0 <br />fSignature <br />Pse/re <br />, __2He ./ Month a e Day <br />1 .?-- <br />Year 2:v <br />Transporters Printed / Typed Name V <br />Signature Month Day Year <br />L <br />. ' !,j• I: , ?,41--1 , 4- .,• ,1t ,, . <br />. ' . . , <br />.. <br />. • , <br />, <br />Discrepancy <br />Discrepancy indication Space 0 Quantity 0 Type 0 Residue 0 Partial Rejection 0 Full Rejection <br />Alternate Facility for Generator) 4.4 -Pe <br />Facility's Phone: <br />ie. <4 . <br />US EPA ID Number <br />Signature of Alternate Facility (or Generator) 1,...& 61 Mn* <br />-- <br />Day Year <br />v <br />.6 r <br />Designated Facility Owner or Operator: Certification of Receipt of materials covered by the manifest except as noted 'n DISMIrl S <br />Printed / Typed Name Signature ' lo nth Day Year