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Non-Hazardous Waste Manifest
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<br />Nun.Hotardous Waste Kr:oldest Cenerator ID Numbei Waste Pruille NJathei
<br />PHLF-20-976 ‘,../.
<br />Waste Tracking (Manliest) Number
<br />Bln BH 1008
<br />Customer Biiling Name and Wiling
<br />ANCON
<br />570 Business Park Drive, Suite 110, Lincoln, CA 95648
<br />Lucie:nor Billing Phone: (310) 933-6068
<br />Generator's Sne Address
<br />Ranieet Singh: 1-5 NB latitude 37.664464 Longitude -121.342946
<br />Tracy, CA 95378
<br />Generalises Mune: (707) 688-0809
<br />Transporter t Company Name
<br />ANCON
<br />US EPA ID Number
<br />CAD980737068
<br />T/ensnorter 2 Company Name 1.5 EPA ID Number
<br />Designated Focility Name end 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 Sh [pone Name Descriptor, .0
<br />Con; an
<br />Total OpenUty Unit WI i Vol Dispose: Method
<br />No, Type
<br />I Non-Hazardous Soil and Rock 1 CM 20 V H131
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<br />Spedal Handling Instructions and Additional Infermallon
<br />Wear appropriate PPE when handling. Job #400-1340024
<br />;4 Hour Emergency Response
<br />800-556-9090
<br />Prone
<br />k-40,\ ../4. 1731-1 1001(
<br />Emergency Response Guide Number
<br />GENERA rOR's / OFEERop's CERTIFICATION; I hereby tecely Piet the above-described
<br />materials one properly classified, descrIbed. packaged, marked anti labeled, and are
<br />materiels are non-hdierdous wastes as defined
<br />in proper condition Mr transpoi Wean according to the
<br />by 40 C.P 261 or any episk
<br />appliceble regulations a
<br />able state law Further, th
<br />the Department of Trensp
<br />I Um ehove named
<br />delOort
<br />Cielernicr'e Offeror's Printer)/ Typed Name
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<br />transporters Acknowledgenleilt of Receipt or Materials
<br />Signature 1
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<br />, iti4b.)Sf ,ONTER SECTION:
<br />Month Day Year
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<br />Trensog Ice I P: Merl/ Typed Name
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<br />Signature
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<br />Month .\ Day .c Year ,
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<br />Transporter 2 Printed i Typed Name 1 Signature Month Day Year
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<br />Dtscrebency
<br />Discrepancy Indication Space CI Cmenlity 0 Type CI Residue 4 DI Partial Rejection 0 Full Rejection
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<br />Alternate FaelkW or Generally) i_
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<br />US EPA ID Number
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<br />Signonorn dr Alternate Facility or Generale')liimtl,s
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<br />Des)unated Feeley Owner or Operate,: Certlace non o/ Reccici at materi3ls covered by Use manifest except an noted In D'screpercy sec :nas„
<br />Printed i Typed Name Signature I Mont"
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<br />I Day Y
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