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ALTA ENVIRONMENTAL.SERVICES,INC. --- -- -- - - ---- - -- - - -- - <br /> 831 Davis St - <br /> Vacavi* CA 95687 <br /> (800)794-2768 <br /> rPow <br /> ' NON=HAZARDOUS 1 Generator's US EPA ID No Manifest 2 Page 1 <br /> WASTE MANIFEST I4 c t App 1 c b 1 E Document No of <br /> 3 Generator's Name and Marring Address <br /> I - 1649 E_ Ch81-1ne11 St <br /> MIJ Ca i teasing <br /> r� t3 sox 5510,3 , Stockton , f�3 95205 Stockton , Ca <br /> 4 Generator's Phone( 209 465-3609 <br /> 5 Transporter 1 Company Nome 6 US EPA ID Number <br /> k bouerle TrucE, irig N / A (408) 927-9321 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number <br /> 9 Di-signaled Faulily Name and Site Address 10 US EPA ID Number A Transporter's Phone <br /> I, �rId J Landf il l , Inc p I I <br /> 8 Transporter's Phoria <br /> I. 1 b Hai a s{ h�,-a d N / A C Facility's Phone 1 <br /> `�aczdv111e= , Ca ( 747 ) A51-327b <br /> 12 Containers 14 <br /> 11 Waste.5hipping Name and Description Total <br /> Unit <br /> --- No I Type Quantity Wt Vol <br /> a }f <br /> � N-,_, I-1 a M a rd o u s hydrocarbon impacted soil , ACCEPT - U 01 1 65 18 yd <br /> � � -- —� _ <br /> WE1G11YASTER CERTIFICATE <br /> 5 IS TO CERTIFY that lite lotowvg described corvnodty was watghed,measured or w ad by a rsargtrrtasler whose spnature is as this certlheale who is a recognized authority of accuracy as prescribed by <br /> pier 7(corivnericing wth Section 12700)of Division 5 of the California Susness and Prdessnrss Coda =nislered by Itse supon of Wasurement Standards of the California Department of food and Agriculture <br /> 1"l trl;E t IhIt7. `I67L)8 �-- <br /> 3 tI s),_ k c lurifit 011t I;u. hili €_ ; DEC 1, 19cm J4 ;n'r8 :0(i <br /> C 5. L olit taodity :I---bOfL <br /> 111'fli l r',r � 1 irr lC_t /Unit : <br /> 10INCrdt o f f I <br /> s 1V1 ,, I [iLi I Total Cha1- e : <br /> 3 <br /> ] r�� Iendereta : bIa. 00 <br /> 951' B r I,li�ll,ilei <br /> Change ; -oil). 00 <br /> ,111 Id i3y It t <br /> a 1 1_ hs. <br /> 1l ,lS <br /> IG117t111 1 r <br /> ctr = Wt Irf, LhS . <br /> J�ll [DO I+Ic`t ;!t- 1 ;Irk I_I,:,. SHIADY I &')LL- <br /> r t 1 t, 1 t r 1d 'i39t IN91-Vr,"1TUff—. - T r i t,_k I k , 's 69 9 DEPUTY WEIGHMASTER <br /> 16 GENERATOR'S CERTIFICATION I certify the materials described above on this manifest are not bio ederal regulations for reporting proper disposal of Hazardous Wosle Month Do <br /> Printrd/Typed Nome Slynafur Y year <br /> z * 4 r t,.q 1 L12U 9 <br /> T 17 r,onsporser 1 Acknowledgement of Receipt of Materials <br /> R Month Oa <br /> Primed Name Srgngture Y <br /> P <br /> D 18 Trarlsporler 2 Acknowledgement of Receipt of Materials <br /> T Piinled/Typed Name Signature Monr6 Day Year <br /> E <br /> R <br /> y 19 Discrepancy Indication Space <br /> F <br /> 1 20 Fualay Owner or Operator Certification of receipt of waste materials covered by this anifest except as noted in Item 19 <br /> rr 1hT <br /> Y <br /> PA+tectfiTyped Name f Srgnatur Month <br /> i TRANSPORTER #1 <br />