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Non-Hazardous Waste Manifest
<br />GENERATOR
<br />Gererator ID Numbc•
<br />SECTION
<br />Waste Profile Numbe
<br />PHLF-21-558
<br />Waste Tracking ItYlanifes0 Number
<br />gi V\ I C .-cr
<br />Gunintiei Bifiny, NJrne and Marlin
<br />ANCON
<br />570 Business Park Drive, Suite 110, Lincoln, CA 95648
<br />(Sun roan 1111:ing Phone (916) 917_6328
<br />Generator's Sae Agd•ess
<br />Hasib Rasoul Transportation Solutions: 16525 N Highway 88
<br />Lodi, CA 95240
<br />(''''''''' Ph.'" (706) 552-5456
<br />Transporter I Comf,,,ny Name
<br />ANCON
<br />US EPA ID Nianoei
<br />CAD980737068
<br />r,dns:,.orte? 2 c“,q,,,,,„, Nar,,e US EPA ID Num,-
<br />Designated Facility Name and Ste Address
<br />Potrero Hills Landfill, Inc.
<br />3675 Potrero Hills Lane, Suisun, CA 94585
<br />Facll ty's Phone (707)432-4627
<br />US EPA ID Nunrac•
<br />Waste Shipping Name and Description
<br />Corp, incirs
<br />T ritm Guarn ty Un 1 WE (Von Disposal Method
<br />No TOP,
<br />I Non-Hazardous Soil and Rock 1 CM 20 Y H131
<br />2
<br />3
<br />4
<br />Special Handl ng Instructor's and Acciticnal Information
<br />Wear appropriate PPE when handling. Job # gen-13 -3 3257 24 HOW Emergency Response Prone
<br />800-556-9090
<br />Emergency Response Gu de Number
<br />GENERATORS /OFFEROR'S CERTIFICATION I hereby certify that the above ide;cribed materials are nor, hazardous wastes as defined :ay 40 CFR 261 Of any appficable state law FlY1110% that the above named
<br />materials arc properly classified, descrIped, pack,oged, marked and labeled, and me In proper condition for transportation accord rig to the applicable regulators of the Dettalinent of Transportation
<br />Generator's Offeror's Printed I Typed Name
<br />Roger Chesshire on behalf of Hasib Rasoul Transportation S
<br />Signature
<br />Roger ChesshireL'f.,=.:,',In';`',.;cu7
<br />Month
<br />July
<br />Day
<br />6
<br />Yea,
<br />2021
<br />TRANSPORTER SECTION
<br />TT ansport,C, Ark owledgement of Receipt of Mater rii,
<br />transparter I Priotec i Typed Name
<br />7-aszA2 A-11,Yro 6
<br />Sqnat II 1411, E.),,..,..._7
<br />V /
<br />, 26yea, 24
<br />Transporter 2 Printed / Typed Name Sipii ItiMe t410,71 Cr, Yu.,
<br />DESIGNATED FACILITY SECTK`N
<br />'6,..„•
<br />Discrepancy 1...,
<br />Discrepancy Indication Space ..3 Quantity ....1 Typa '..) Pi sidia -If t2I?Re1ri.-tion J Full Reject on
<br />Alternate Fur/ ty par Generator) . /Of
<br />)US
<br />Facility's Phone- ..../ • Col y
<br />.r, 4,
<br />EPA ID Numhei
<br />0
<br />Signature of Alternate Facility (or Geneiato,) A-‘4./. e.)
<br />e...1._ Wrafr
<br />„
<br />Day Year
<br />K. Designated Facility OVelet or Operator Certification of Receipt of materials co ered by the manifest erects; ns noted or Discrepeats.e,c, e
<br />Printed I Typed Name Signalue Montli Day 1 Year
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