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ALTA ENVIRONMENTAL SERVICES,INC. <br /> 831-Davis SL--- --- - _ <br /> [ �� „ <br /> Vacavile, CA 95687 ! <br /> �•yi f (8a0)T.34-2768 <br /> NON-HAZARDOUS I Generator s US EPA ID No Document rifest 2 Page 1 <br /> WASTE MANIFEST Ivor Appl i4 ablf of <br /> (' <br /> 3 Generators Name and Mailing Address 4C t An . <br /> ti �lh rcJ C�1 Leas µ 1644 9 E. Channell St <br /> ing <br /> l; O kite. 55103 , Stockton , Ca 95205 Stockton , Ca . <br /> 4 Generators Phone( 2 0 9) 465-3609 <br /> 5 Transporter 1 Company Name d US EPA ID Number <br /> R 8autpr 1 a Z rucking N / A (408 ) 927--9321 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number <br /> 10 US EPA ID N <br /> 4 Ds srgnated Facility Name and Site Address umber A Transporter':Phone <br /> P .:and J Landfill . Inc - B Tronsporter's Phone <br /> 1,426 Hay Road N / A C Facility's Phone <br /> Vacaville , Ca ( 707 ) 451 -3278 <br /> 12 Containers 13 <br /> 11 Waste Shipping Name and Description <br /> Total Unit <br /> No I Type Quantity W! Vol <br /> arJon-hazar does hydrocarbon ilr,pacted so-i l , ACCEPT # 01 165 18 yCIS <br /> WEIGHLUSTER CERTIFICATE <br /> HIS IS TO CERTIFY that the hollowing diiimu bed commodity was"lghect measured a taunted by a weighrnasler whose s nature Is on thus cadificate,who Is a ncoaztlzed�Department do+Fo�oasar dr.encu u o! <br /> rippler 7(comrroncing with Seclron 127M)of Division 6 of the C 1ifornla Busyness and PtofeEsons Code administered h the Division a Messuremsm Standards at the California <br /> W o 1114,yi,.5r, 1 t !'i 171MC-1 NO. s 76801 <br /> lr > ( �trtilt y �Jt vt'x0�illlk:llt Co. DALE: DEC 1, 1993 <br /> ' Ht-ty f`— V c«vi Ile, Ca. Culnm+�daty : C- SOIL <br /> _E11)lll . 1`,j „' f f) / I'r'xc�t,/Unit; • <br /> ! lt t IIUak, rj(14? 'IaLllti �+i / f1� r <br /> t ot:al. Charge : <br /> Tendered :: $0. LIVI <br /> t � ) ! j) /- k'11nL<�, : �slt. <br /> 1 11. (1 ,.( L �. � i 9 6 Change 00 <br /> 00 (H) (it cr:_ (Jt� l l)lit l-lja. <br /> Ir 701(1 <br /> kar't t1 tijlil. l-L 5. Mfr �y <br /> r• ul� .)fA 1 WL-i, s '- 3 Iti1( (J`a. -- ) <br /> ()N Y HALL <br /> p� ER g �,�p��� <br /> fI(�fn ,rsi :ifr Cv�lI fl`' i_CSEa. 1 s'sl(.( I ` ''_fes` DEPUTYWEIGHhAASTER <br /> ld GENERATOR'S CERTIFICATION I certify the moier,ols described above on this manifest are noy -jecttir4r6rol regulations for reporting proper disposal of Hazardous Waste <br /> Monih Day Year <br /> Printed/Typed Name SrgnaTur ~! <br /> T 17 Transporter I Acknowledgement of Receipt of Materials _ <br /> R — 12 y.{ <br /> N y, /Typed Name <br /> P�cJ Signa'uy �y o Duyr <✓ <br /> 5 I- <br /> P — <br /> 0 IS Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> IR <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I -- <br /> 1 <br /> I 20 Facility Owner or Operator Certification of receipt of waste materials cov4byonrfesLexcept noted in Ite 19 <br /> T _ <br /> Y —'--- ---- Mo I y e <br /> Print ed IN -- r <br /> I I I + <br /> �• TRANSPORTER #1 <br />