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Non-Hazardous Waste Manifest <br />NoniHazardous Waste Manifest <br />GENPATOR <br />Generator ID Number <br />SECTION <br />_ .. . <br />Waste Prattle No <br />PHLF-20-971 <br />Waste Tracking 011anifesti Number <br />Bin HB 1016 <br />c.s....... owing Name and Marlin; <br />ANCON <br />570 Business Park Drive, Suite 110, Lincoln, CA 95648 <br />Grunnier 041ling Phone: (310)933_6066 <br />Genet ator's Site Address <br />SKS Transport Line Inc.: 11616S Nation Road, Lathrop, CA 95330 <br />c''''''''ll""'' (510 ) 374-2586 <br />AMON A) i Teat:water 1 Comnorty Name ,US k AA 61\ -rei/Ck 1(1) <br />EPA ID Nwribe: CA CO CO 1.91, 710 <br />..C.A0880?8•7068 <br />TgartipAtto 2 Company Name US EPA ID <br />Designated Facility Name Aril Site "redress <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 Shipping Name and Description <br />Container s <br />1otal Quantify Unit WI / Vol DISPOSDI Method <br />No Type <br />' Non-Hazardous Soil and Rock 1 CM 20 Y H131 <br />.1 <br />3 <br />... <br />Wear appropriate PPE when handling. Job #400-13-29708 <br />24 Hour Emergency Response Phone <br />800-556-9090 <br />Eroergency Response Grade Number <br />J <br />GENERATOR'S f OFFEROR'S CEGT1FICXTION: I hereby certify that the aberveides diet' inattUalS are non4ra2ardeue wastes as defined try eg CFR 261 or any iropt oble state law Further. that the abova named <br />materials are properly classified, described, packaged, marked and labeled, and ale In proper condition far transportation according to lee applicable regulations a the Department of Transportation. <br />Generator's Offeror's Prinled / Typed Name WC) &Week <br />el 641-114' i dr 6 KS <br />— Signature <br />- <br />Moollt 16. '-i <br />! <br />Weer <br />C)ee) <br />• Trz4NSPORTFR SFC TIM <br />of Materials Tr apsuotter's Actinowledsernent of Receipt <br />Transpener 1 Printed /Typed 'lamer) L)k, z;;; iire,41 Signallere . <br />if t <br />Magni Day <br />C.) <br />... <br />r tianspciter 2 Printed / Typed Name Signature Menu, Day Year <br />Ckscropal+cy <br />J <br />Pi:SQNAIE•ti FA.CO. trr 5ECTIC*1 <br />Cssueowisy Indication Space j Quantity U TYPO 14 ResidUv -..1 Partial Rejection 1.1 Full Rejection <br />All.noto Faciley lea Generatoil <br />11* <br />Facility's Phone <br />US EPA ID Number, <br />Signature of Alternate Facility (in Generator' oei , <br />._. 4.0.k... t.. ip <br />js <br />aa,,..., <br />''' '- ' IP <br />Day Veal <br />.4‘. <br /> <br />V ., <br /> <br />DtAigOMed Facility Owner or Ofte1.10r. C..4111;Catiell of Receipt of materials covered by the manifest except as naiad In Orsc sec c,9 <br />Printed I Typed Neat° Satur igne Year