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Non-Hazardous Waste Manftest <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 />Cugomer 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 />Transporter 1 Company Name <br />ANCON US EPA ID Number <br />CAD980737068 <br />Transporter 2 Company Name <br />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 (,/77D • 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 Phone <br />800-556-9090 <br />Emergency Respcnse 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 applicable state law Further, that the above corned <br />materials are properly classified, described, packaged, marked and labeled, and are In proper condition for transportation according tot e applicable regulations o the Department of Transportation. <br />Generator's Offeror's Printed / Typed Name <br />4-191) 0\D <br />sirturr,--, Month <br />i <br />Day Year <br />_ • . : ' ' ., , . . y , : i7:.T.,--- . - • ,- 1 ...,, . ,:op,,,_ - •-' ., :-.. <br />-71.?*•,...AP, • <br />Transporter's Acknowledgement of Receipt of Materials <br />Transporter I Filintee i Type <br />441) PI it9 F <br />my <br />.-6r-e-7 <br />? Si ....e2-17 <br />Month j,,, <br />0 tif <br />Day <br />t 7- <br />Year <br />20 <br />Transporter 2 Printed / Typed Name Signature Month Day Year <br />I i ...: .. • <br />, ... . <br />Discrepancy <br />Discrepancy Indication Space 0 Quantity 0 Type Cl Residue 0 Partial Rejectio4. CI Full Rejection <br />Alternate Facility (or Generator) <br />Facility's Phone: _' <br />V?,,e., <br />-19 ei> <br />ilk. 6.1 <br />US EPA ID Number <br />_', <br />Signature of Alternate Facility (or Generator) Month <br />‘ <br />••• . , Day ---' <br /> <br />, ./L. <br />,v.. <br />% <br />Year <br />Designated Facility Owner or Operator: Certification of Receipt of materials covered by the manifest except as noted In Discrepancy section %...* <br />Printed /Typed Name Signature Month N Day Year