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0 .3 , 13 <br /> POTRERO HILLS LANDFILL <br /> P.Q.sox es <br /> FattUeld.CA 94533 <br /> T.707432-46 <br /> F:707-426-601336 <br /> (P <br /> LANDFILL <br /> WASTE CONNECTION, POTRERO HILLS LANDFILL <br /> CLEAN SOIL CERTIFICATION <br /> I certify that this load of soil being delivered to Waste Connection's, Potrero Hills <br /> Landfill Is natural and uncontaminated soil, which will be a beneficial reuse <br /> material at the landfill. <br /> I understand that If the soil comes from a site where there has been previous <br /> construction; dumping, spillage or other impacts that may cause the soil to be <br /> contaminated, the soil must be approved by the landfill prior to acceptance and <br /> disposal. I understand there are serious legal and financial penalties that can <br /> result from the wrongful disposal of contaminated soil. <br /> Ta by com>nleted by-the Generarar: <br /> printed Name: ON <br /> I~irm j Company: uP _bjA5V t { + "' <br /> City:._ County: SQUI <br /> 9�F Stgnature: Met <br /> Previous race on or addressf soli: WA 5QU,1 C 5- <br /> Activity generating soil: C�C"6 V P-00 A <br /> This gertification is required far each truckload of soil delivered to the <br /> Potrero Hills Landfiil.'The driver must provide this certification to the <br /> scale house attendant upon arrival at the landfill, <br /> Jobe completed by Scalp hpM Oper fur: <br /> 'truck License Number. V/J I.Aad Size: <br /> Date Received: I 'y I r Collector'initials; <br /> T)r t (-Ane r_j U r(LO-Ai t cl�\A A <br />