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R <br /> 4; W REPUBLIC' NON-HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST <br /> ZP44 SERVICES <br /> If waste is asbestos waste,complete Sections 1,11,111 and IV <br /> 6403279 If waste is NOT asbestos waste,complete Sections 1,11 and III <br /> 1. GENERATOR (Generator completes la-r) <br /> a.Generator's US EPA ID Number b.Manifest Document Number c. Page 1 of <br /> N/A 1 <br /> d.Generator's Name and Location: e.Generator's MailingAddress: <br /> Associated Tractor Service 1ric Associated ractor,Service Inc, <br /> 1323 Charter Way 1323 Charter Way <br /> f. Phone: <br /> Stockton,CA 95206 209-466-3003 g. Phone.Stockton CA 95206 <br /> If owner of the generating facility differs from the generator,provide: <br /> h.Owner's Name: I J.Owner's Phone No.: <br /> j.Waste Profile# k.Exp.Date I.Waste Shipping Name and m.Containers n.Total o.Unit <br /> Description No. Type QuantityW of <br /> C 10 <br /> 4M420" 3/11/2021 Soil <br /> I I I I I <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR 261 or any applicable <br /> state law,has been properly described,classified and packaged,and is in proper condition for transportation according to applicable regulations;AND, if this <br /> waste'Itreatnlent residue of a previously restricted hazardous waste subject to the Land Disposal Restrictions. I certify and warrant that the waste has <br /> s <br /> been tr, tq0_0r-1Fccordance,4vdh 4 requirements of 40 CFR 268 and is no longer a hazardous waste as defined by 40 CFR 261. <br /> Generator Authorized A2ent Name(Print) q. Si nature r. Date <br /> 11. TRANSPORTER (Generator completes Ila-b and Transporter completes Ile-e) <br /> a.Transporter's Name and Address: <br /> b. Phone: <br /> c.Driver ITame(Print) d.Signature e. Date <br /> Ill. DESTINATION (Generator complete Illa-c and Destination Site completes lild-g) <br /> a.Disposal Facility and Site Address: c.US EPA Number d. Discrepancy Indication Space: <br /> Toward Landfill <br /> 9999 S.Austin Rd. <br /> b. Manteca,CA 0036 2W- <br /> I hereby cer&tf)etlhe above named material has been accWeoVnd to the best of my knowledge the fare I is true and accurate. <br /> Ce.Name utAorized Agent(Print) I f.Si nature <br /> IV. ASBESTOS (Generator completes lVa-f and Operator complete lVg-i) <br /> a.Operator's Name and Address: c. Responsible Agency Name and Address: <br /> b.Phone: d. Phone: <br /> e.Special Handling Instructions and Additional Information: <br /> f.0 Friable 0 Non-Friable El Both %Friable %Non-Friable <br /> OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name <br /> and are classified,packaged,marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and <br /> national governmental regulations. <br /> g.Ciperator's Name and Title(Print) I h.Signature I. Date <br /> *Operator refers to the company which owns,leases,operates,controls,or supervises the facility being demolished or renovated,or the demolition or <br /> renovation operation or both <br /> REV 01/14 DESTINATION RETURN RS-F11A <br />