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Non-HaurdousiNaste Manifest <br />I.. <br />L... <br />Nbn Ha:nicleuti Waste Mani'eSt <br />GENERATOR <br />— ' . — — .,. • - <br />Generator ID N.Iirt..ii• <br />SECTION <br />Waste Prnt c Number <br />PHLF-21-594 <br />Mune., War.t, T 'act-1,-; litaairi: st) <br />Bin 1109 <br />Cuttim.e• 9 ring NAM', and ritaailii: <br />ANCON <br />570 Business Park Drive. Suite 110, Lincoln, CA 95648 <br />Cintomer Billing Phone: (916) 917-6328 <br />Generator's Site Address <br />Hasib Rasoul Transportation Spill Solutions: 16525 N Highway 88 <br />Lodi, CA 95240 <br />Generator's Phone: (706) 552-5456 <br />Tr.msrmrter 1 Company Name <br />ANCON <br />US EPA ID Nernne• <br />CAD980737068 <br />Trarriamter 2 Cn•rmarri Name US EPA ID Number <br />Designated Facility Name and Site Address <br />Potrero Hills Landfill, Inc. <br />3675 Potrero Hills Lane, Suisun, CA 94585 <br />Fl"-'cl: 'is 1.1'-'" (707)432-4627 <br />US EPA ID tri:mbei <br />tAra,te Shipping Name and Description <br />C.nrila,er,.. <br />Total Daintily tin I 1.•15 i V, Dispe-la! Method <br />Nu lit,' <br />I Non-Hazardous Soil and Rock 1 CM 20 Y 11131 <br />2 <br />4 <br />.. <br />Special 1-landing Inst,uctions and Additional Information <br />Wear appropriate PPE when handling. Job #400-13-33251 <br />24 Hour EmereAncy Ile:pante iltir:le <br />800-556-9090 <br />Emergency Response Guide Number <br />GENERATOR'S / OFFERORS CERTIFICATION: I hereby certify that the above-described materials are non-hazardous wastes as defined by 40 CFR 261 or any appli able state law. Further, that the above named <br />materials are properly classified, described, packaged, marked and labeled, and are In proper condition for transportation according to the applicable regulations of the Department of Transportation. <br />Generator's Offeror's Printed I Typed Name <br />Roger Chesshire on behalf of Hasib Rasoul Transportation <br />Signature <br />Roger Chesshi re r'grigf;',,,r,7740 ,`";*," <br />Month <br />July <br />Day <br />20 <br />Year <br />2021 <br />.......• .. <br />TRANSPORTER SECTION <br />_. _ <br />transporters Acknowledgement of Recr at of Materials <br />Ira.,...iariiter I Printed / Typed Nome <br />(.1-445 Alliajet. <br />obi 1 / Sig-tater,' I q , A. !).. iitoritti Day ....,) / <br />Transporter 2 Printed / Typed Name Signature f.t.:iti, t).1 Y1,11 <br />: ii:d.., <br />Discrepancy <br />DESIGNATED FACILITY S.ECTION <br />..—• , <br />L <br />„. <br />Potrer Hill <br />Discrepancy Indication Space J Cluantly UTyr', U Pair, <br />aqclfill, inc. <br />U Partial Rojectioa z, Fell Pejei-iibn <br />Alternate Facility (or Generator) <br />JUL 2 6 2021 <br />Facility's Phone: <br />US [PA ID Numbei <br />Signature of Alternate Facility (or Generator) N6,14, <br />Notosliu <br />i <br />Day VC:37 <br />Designated Facility Owner or Operator: Certification of Receipt of materials covered by the manifest except as noted in Discrepancy se iPunders <br />Printed/Typed Name Signature Mcnt!i Dly vi, ,7