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Non-Hazardous Waste Manifest <br />_r_..:...r.11..,-.........—:._ ._ ._ <br />Nun-Hanudous Waste Manifest <br />G-fiNERATOP <br />Generator ID Number <br />$E011— <br />Waste Profile Norther <br />PHLF-20-976 <br />Waste Tracking (Manifest) Number <br />Bin BI-1 1010 <br />C1,5101110 fill!Ille Nalltlt! and Marlin& <br />ANCON <br />570 Business Park Drive, Suite 110, Lincoln, CA 95648 <br />CIAIOITIN ablinG Phone: (310) 033.6060 <br />Generator's Sae Address <br />Ranjeet Singh: -5 NB latitude 37.664464 Longitude -121.342946 <br />Tracy, CA 95378 <br />G'n nr'it" Pim2I (707) 688-0809 <br />Transporter 1 Company Name <br />ANCON <br />US EPA ID NUM bar <br />CAD980737068 <br />'transporter .2 Company Nerne US EPA ID Number <br />Designated Facility Name and Sfie Address <br />Potrero Hills Landfill, Inc. <br />3675 Potrero Hills Lane, Suisun, CA 94585 <br />Fact/PY's Pliorte (707) 432-4627 <br />US MN, ID Number <br />Waste Shipping Name and Desorption <br />Contatnera <br />UnIt Wt /Vol <br />No, TA. <br />Total Ottaregy Casprival Meghnd <br />1 Non-Hazardous Soil and Rock 1 CM 20 Y 11131 <br />2 <br />3 <br />4 <br />Special Handling Instructions and Additional Information <br />Wear appropriate PPE when handling. Job # 400-13-30024 <br />24 Moor Emergency Response <br />800-556-9090 <br />Phone <br />tGy44- 1023 Emergency Response Guide Number <br />GENERATOR'S /OFFEROP.'S CERTIFICATION, I hereby carfiry that the above-descrIbed meterlais are non-hazardous wastes as defined by 40 CFR 261 Or aoy mill able state law Puitha,. that <br />materials are pmperly class-Mort described, packaged, marked and labeled, and arc In proper condition for Iransponalon according to I/o applicable regulations of Ina Department or Transportation <br />the above named <br />Generators Olferor's Printrx1 I Typed Nonni <br />/ <br />o r r •. <br />L <br />TR <br />.1.. <br />Trenvortm"s Acknowledgement of Receipt, orgIetativrals <br />Signature 40 <br />tit <br />. <br />irkI4SPORTER SECTION ': • , <br />tdonlh Day <br />I 1,47)._ <br />Year <br />7,p0,,,,itor I Printed I Typed Name <br />_e I gcSia tel ORANIO St9-ii <br />Signature Month 1 Day 6 Year <br />Transporter I Printed /Typed Name <br />Discrepancy <br />Sagreelie <br />DESIGNATED FACIL I rv SECTIpq. .-..': <br />Month <br />i • <br />Day Year <br />OlsevepancylndIcation Space C2 Ouantrty CI 440101 gilljejfirS f Y ,P,110 j. ci Partial Rejection a Fa Reim:Con <br />Alterriute Feglity be Generator) <br />Pd. 04) It r <br />' ' (14 2021 <br />Facility's Phone <br />'4114aiiitill, J111.141....w,a irs 14_44._________ <br />US EPA ID Number <br />Signature of Alternate Facility inr Generaing Month Day Year <br />DesIgnateo Earthly Dwrier or Operator. Certification of Receipt or materials revved by the inatillesi except as noted le Discrepancy section <br />Pitted/Typed Name inature Sg Monne I I Day 'Ykdf