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Non-Hazardous Waste Manifest <br /> GENERATOR SECTION <br /> Non-Hazardous Waste Manifest Generator ID Number Waste Profile Number Waste Tracking(Manifest)Number q <br /> PH-22-502 �jZ9 7_ oy,3 <br /> Customer Billing Name and Mailing Generator's Site Address /� <br /> ANCON ProPacific Fresh:1-5 North at Exit 490 <br /> 570 Business Park Drive,Suite 110,Lincoln,CA 95648 Lodi,CA 95242 <br /> Customer Billing Phone: (916)917-6328 Cencrator'sPhonc (530)893-0596 <br /> Transporter t Company Name US EPA ID Number <br /> ANCON CAD980737068 <br /> Transporter 2 Company Name US EPA ID Number <br /> Designated Facility Name and Site Address US EPA ID Number <br /> Potrero Hills Landfill,Inc. <br /> 3675 Potrero Hills Lane,Suisun,CA 94585 <br /> Facility's Phone: (707)432-4627 <br /> Containers <br /> Waste Shipping Name and Descrlpuon Total Ouantity Unit Wt/Vol Disposal Method <br /> No. Type <br /> t Non-Hazardous Soil 1 CM 20 Y ADC <br /> 2 <br /> 3 <br /> 4 <br /> Special Handling Instructions and Additional Information 24 Hour Emergency Response Phone <br /> Wear appropriate PPE when handling. Job#400-13-38502 800-556-9090 <br /> ) <br /> �I 2 LL 0IJ 2 Emergency Response Guide 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 paw. Further,that the above named <br /> materials are properly classified,described,packaged,marked and labeled,and are In proper condition for transportation according to the applicable regulations of the Department of Transportation <br /> Generator's Offeror's Printed I Typed Name Signature Month Day Year <br /> o vWN•9^�h Aoprr Pa <br /> Roger Chesshire on behalf of ProPacific Fresh Roger Chesshire,;,,muea,.oa-�,.-0roo June 14 2022 <br /> TRANSPORTER SECTION <br /> Transporter's Acknowledgement of Receipt of Materials <br /> Transporter anted/.Typed Name Sig tu,e l Month Day �,S Year <br /> P-01�7, <br /> /Transporter 2 Printed/Typed Name Signature Month Day Year <br /> A <br /> DESIGNATED FACIL IT't SECTION <br /> Discrepancy <br /> U <br /> Discrepancy Indication Space 3 Ouantity ❑Type O Residue ] Partl�Ryection 3 Full Rejection <br /> Alternate Facility(or Generator) VJ US EPA ID Number <br /> Facility's Phone: <br /> dJ <br /> Signature of Alternate Facility(or Generator) Month Day Year <br /> Designated Facility Owner or Operator:Cert)lcatlon of Receipt of materials covered by the manifest except as noted In Discrepan 6ectuc. <br /> Printed/Typed Name Signature (/ ionth Day Year <br />