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Non-Hazardous Waste Manifest <br />GEN ERAIttrc <br />. ',.-,'.., <br />SEC TiON <br />Non-Hazardous Waste Manifest Generator ID Number Waste Prete Number <br />PHLF-21-335 <br />Waste Tracking (Manifest) Number <br />LMH ER Lathrop <br />CirStomor Billing Name and Mailing <br />ANCON <br />570 Business Park Drive, Suite 110, Lincoln, CA 95648 <br />CUSIOITler Billing Phone: (310) 933_6068 <br />Generator's Site Address <br />Mike Lowrie Trucking: Across from 16777 South Howland Road <br />Lathrop, CA 95330-9777 <br />Generator's Phone: (707) 678-3018 <br />Transporter 1 Company Name <br />ANCON <br />US EPA ID Number <br />CA0980737068 <br />Transporter 2 Company Name US EPA ID Number <br />Designated Facility Name and Ste Address <br />Potrero Hills Landfill, Inc. <br />3675 Potrero Hills Lane, Suisun, CA 94585 <br />FaclIty's Phone: (707) 432-4627 <br />US EPA ID Number <br />Waste Shipping Nam* and DesaiptIon <br />Containers <br />Total Quantity Una Wit Vol Disposal Method <br />Na Type <br />I Non-Hazardous Rock and Soil 1 CM 20 Y 1-1131 <br />2 <br />3 <br />4 <br />r3ra.lril Handling instructions and Addition.' information <br />Wear appropriate PPE when handling. Job # goo. P • 5 2.2•/?ci <br />gtiN qt- 2* 10 1 2— <br />24 Hour Emergency Response Phone <br />800-556-9090 <br />Emergency Response Guido 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 naired <br />materials are properly clissified, descrbed, packaged, marked and labeled. and are In proper condition for transportation according to the applicable regulations of the Department or Transportalion. <br />Generator's Offerors Printed / Typed Name <br />Roger Chesshlre on behalf of Mike Lowrie Trucking <br />Signature <br />Roger Chesshire=tf c,"71:;;;;,;,72,`.70,,,-"" <br />Month <br />April <br />Day <br />23 <br />Year <br />2021 <br />- <br />,.., <br />TRANSPORTER SECTION <br />Receipt of Materials Transporter's Acknowledgement of <br />if orl-.0-3t t..r 1 Nola 0 / Tyr <br />-r <br />rod . Iri kr iiii y:-4, <br />ele-e„ 7 f..4.-145 te-t--e-f. 'I Day Year <br />20 V <br />Transporter 2 Printed / Typed Nan-.e Month Day Year <br />0.1%101VATED facr.rry sEcii(Irc <br />Discrepancy <br />Discrepancy Indication Space 0 Ouantily 0 Type Ojesidue 0 Perlis; Rejection 0 Ful Rejection <br />Alternate Facility (or Generator) •r• <br />Facility's Phone! <br />US EPA ID Number <br />Signature of Alternate Facility (or Generator) c e- <br />144 <br />03 <br />*-- . ia\Oraonth Day Year <br />Designated Facility Owner or Operator. Certification of Receipt of rnatenals covered by the manifest accept as ..t.4 en1 screelvy section <br />Printed I Typed Name Signature Month Day Year