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Non-Hazardous Waste Manifest <br />4 —.1tir ii. • i ' - ;GE N ERAToit ' .• . . <br />Non.lida aidnus Waste. Manifest Generator ID NUMbilf Waage Profile Nombre <br />PHLF-20-976 I <br />waste TrerSerg lNarefeWNon-bor <br />Bin BA rem. 10 IC.) <br />Custonlur Pilling Name and Malting <br />ANCON <br />570 Business Park Drive, Suite 110, Lincoln, CA 95648 <br />c-,,,Iomer F1IIIieg Pliwiei (310) 933-6068 <br />Generator's Site Address <br />RanJeet Singh: 1-5 NB latitude 37,6644-64 Longitude -121.342946 <br />Tracy, CA 95378 <br />11"cal°6 Plinn'' (707) 688-0809 <br />Transporter 1 Company Name <br />ANCON <br />US EPA 10 Number <br />CAD980737068 <br />'tonne:Me- 2 Cam:Deny Name US EPA ID Wanner <br />Designeted Facility Name and See Address <br />Potrero Hills Landfill, Inc. <br />3675 Potrero Hills Lane, Suisun, CA 94585 <br />Facility's Pim,' ei (707) 432-4827 <br />US EPA 10 Number <br />Wriscle ShiPping Name and Description <br />Containers <br />UM* Wt t Vet <br />No, Type <br />Total Quantity Disposal Method <br />I Non-Hazardous Soil and Rock 1 CM 20 Y H131 <br />Special Handitig leatrucUons and Additional Information <br />Wear aepropriate PPE when handling. Job #400-13-30024 <br />24 Hour Emergency ReSDOIISO <br />800-556-9090 <br />Phone <br />gih.14-loit, Emergency Response Gulde Number <br />GENERATOR'S'. I OFFERORS CERTIFICATION thereby certify that the ehnve-cleepribed Itleterle Is in nornhaaardous wastes as delned by 40 CFR 261 or any email <br />materials ere pi uparly cleastiled, described, packaged, marked and labeled, and are In proper condition for transportation According to the et:Tenable reputelluns o <br />able state law. Further-, that <br />the Dermdment or IlamPoltalitin. <br />the above named <br />Generator's Offer ons Printed/Typed Name <br />i 1 ' 6' ,(/1 4 0 ti • e <br />Sig neture <br />.. <br />ec -f <br />Month Day Year <br />.2. 1 <br />t , r WO <br />i i tRittiMnili 1 . <br />Transpneees Anknowledgenient of Receipt of Materials <br />Transporter 1 <br />A <br />li Prinle ruled/Arno <br />l are / —;11.4f it <br />i 41 Month Day Yeteir i <br />..Z. I <br />Transporter a 1",Mled !Typed Name Month Day Yew <br />.Cliiii i <br />nem.. <br />.. •_:::: ...4..t. .1. V, ._ L., L. <br />Discrepancy <br />Discrepancy lirdication SPeca a Quantity 0 Type la Residue 12 Partial Rejection El Full Rejection <br />Ah.errune Earthly (or Generator) <br />ein Fuotay% N.,,e, ,..... <br />Us EPA It) Number <br />Signelure of Alternate Facility Or Ceneraree <br />s \ .., <br />-4. <br />hiclith Day Year <br />Designated Facility Owner m Operator, Certification of Receipt e materials coved by the Planiresls>444,0/HrjelOprf ft". 0 r "'lir.' <br />-Or <br />Illnied I 7 y'r,-ed Nti S grretursi Month Day Year <br />sit