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NON HAZARDOUS 1.Generator IU Numter 2 Page i of 3.Enro genu/Respcn o,Pnono J 4,Waste Tracking Number <br /> W <br /> t,1ArrI1�sT QC <br /> I C E - U 2 1 7 1 7 - ? <br /> S.Gsr ratzr 5 tEarr#Bid hia.mg A dressAtL ARD Gereralotc:y <br /> s a Addrss[i d Yererd Liar,,ra`rs s <br /> g addl <br /> PACIFIC ETHANOL STOCKFON LLG <br /> 30n NAW DR <br /> STOCKTON CA 95206 <br /> Generates Phone: <br /> wee 6 Transporter S Camp m/ US,EPA fD M=W, <br /> 7.Transporter 2 Company Name <br /> U.S,EPA i0 NetnbPr <br /> 8.Desiwted Facer/Name and Sita Address U.S.EPA ID Nunft <br /> POTRERO HILLS LANDFILL <br /> 3,575 POTRERO HILLS LN <br /> SUISUN CITY CA 94555 <br /> Focht s Phone: <br /> 9.waste Shi;pirg Name and Desdplen 10.Cen&mrs 11.Taal 12.Unit <br /> 1io. I Typo oualmy Wive. <br /> )NON-WARDOUS WASTE,SOUR(SOIL) <br /> o o I CIS <br /> z <br /> w <br /> ca <br /> 3. <br /> 4. <br /> 13.Sp pal Hardog W-v 6vW 95 and Wbcr'-f eorr ahca ,�f�`Y i� o �` <br /> 1:03TI10921 � d I- 75475 3 <br /> F-�3Fl:2# PB-.J -17-lJ 6 Wl/AF9 ad Ala F (> <br /> �tr1� <br /> AJRQ, dbtl�-409 z <br /> 14.GENERATOR'SMFFERO R'5 CERTIFICATION;I hereby&:lana mai the con—"cf the are lu.Iy and acmr.ta?l decried atcve by to proper s`lppirg Fame,and are dass_led,packaged, <br /> marked and kMecilptacarded,end are in all wpct15 in prppercondi im for lzastslx ccvding to a4lic&e intemabonal and rational gNeaumn gulattom <br /> {xar>Ericfsdtltfercr s PdntBtVT Har,c A� $g coeurs r �� Anih Day Year <br /> ' /rFy��j/,�r r 0 I ry <br /> 1fi.lr'.errationzi£"'z�trcnLS <br /> ❑ AM Imptr io U.S. ❑Espert V-S. Ptr;cI en1ry:'cxiV <br /> — Trarmcder Scnalure fcr its only): Clete leavlr U.S.: <br /> ¢ 16.TransportarAckrw.+fedgm2nl G Retelpt of Materials <br /> Transptrer I Rinteayped Name S:grmvre Morin Dal Year <br /> CL <br /> Taanqptrtar Pdrtle2�fypedNArSN S'gn51 1,*::'nth Ray You <br /> 17.Discrepancy 1�I <br /> 17a.D-weparcy lraca=cn Saace E—] �cj <br /> Qrf El Ty;? f J Re^.,: E]Poral Nd. 11 1 F;fi:;==e_,. <br /> Alanilesl Reference l.umter <br /> r 17b.Allemale Faotty(w Genemtarl U.S.EPA ID Number <br /> v <br /> LL Faai^js Preis: <br /> 17c.5gnaiure of All rule Fa-*y(cr Gervaldr) t,lzmh Day Yea <br /> Q <br /> w <br /> w <br /> v <br /> 15.Desigraled Wily(Prmmror Opera:er:Cemlimda of re i of materials covered by the marslest except as ratted in Item, <br /> PrintWyped Mame fLA, I Signature I o. D. !e <br /> 169-BLC-0 5 11977(Rev.9109) DESIGNATIED FACILiT`f T GENER^l OR <br />