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�0®NORTHSTAR Non-Hazardous Waste Date: 11'03'21 <br /> D� enwiaoNuc,Nrn�cxoue,irrc. <br /> Client#' 10207984 <br /> Manifest Document#: 106867 <br /> WASTE ORIGIN <br /> Section 1. <br /> Origin Location; FedEx Ground-5655 Hood)May,Tracy CA (Phone: 209.839.2050 (updated: <br /> 312412021) <br /> Address: 5655 Hood Way <br /> City: Tracy State; CA Zip: 95377 <br /> Section II. <br /> Description Number of containersType of Container Qty I Units <br /> Grit Trap Waste 1 T 59 1 Gallons <br /> Description Number of containers Type of Container Qty Units <br /> Description Number of containers Type of Container qty Units <br /> Section III. Special Handling Instructions <br /> Section IV. Generator Certification <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260.10(sails)or any applicable state law,is <br /> not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law,has been properly described,classified and packaged,and is in <br /> proper condition for transportation according to applicable regulations. <br /> Customer Name: Adam Lee Signature: <br /> OWNER/TRANSPORTER <br /> Section V. <br /> Name of Co.: Northstar Environmental Group,Inc. Phone; (800)449-7504 <br /> Address: 417 N.Blythe Street-Gallatin,TN 37066 <br /> Driver: Richard Burke <br /> Receipt of Material (Driver's Signature): Y Date: 11/03/21 <br /> DESTINATION <br /> Section VI. <br /> Disposal Site: Potrero Hills Landfill Profile#: PHLF-18-919(Parent profile) <br /> Address: 3675 Potrero Hills Lane City: Suisun <br /> State: CA Zip: 94585 <br /> Signature: � Date: 11/05/21 <br /> Section VII. Special Notes <br />