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111111111111,1110=MI <br />Please print or type. Form designed for use on elite (12-pitch)typewriter ERATOR o. I NON-HAZARDOUS <br />WASTE MANIFEST <br />, <br />1. Generator ID Number <br />N A <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />1-8004994672 <br />4. Waste Tracking Number <br />N H - 1 8 0 8 2 0 - 0 1 <br />5. Generator's Name and Mad g Address Generator's Site Address (if different than mailing address) <br />ALPINE HEUCOPTER SERVICES ALPINE HEUCOPTER SERVICES 11001 WHWY 12 6660 MAYBECK RD <br />LODI CA 15242 STOCKTON, CA CA 28206 <br />Generatoes Phone: 202 368-8530 I <br />6 Transporter 1 Company Name U.S. EPA ID Number <br />NRC ENVIRONMENTAL SERVICES INC. ICAR 0 0 0 0 3 0 114 Transporter 2 Company Name U.S. EPA ID Number <br />I <br />Designated Facility Name and Site Address U.S. EPA ID Number <br />PIOTRERO HILLS LANDFILL <br />3675 POTRERO HILLS LN <br />SUISUN CITY CA 94585 <br />Facility's Phone: 707 432-4627 ICARO 0 0 0 8 94 0 6 <br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit <br />Ho and Packing Group (if any)) No. Type Quantity Wt.Nol. <br />I • Non-regulatid rruterlal (Soil) <br />001 cm 22) Y t GENI 2 <br />3. <br />4 <br />Special Handling Instructions and Additional Information <br />JOB# 18 0 8 2 0 <br />PROFILE* PH-2 2-65 6 <br />e5 "--3 <br /> <br />GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br />GeneratoeslOfferoes Printed/Typed Name Signature Month Day Year <br />Ow 8q,,, of 41.0 ; A..1 fie-L-1 ceeleAtSi-a_vt, cit.-, I 6 I 22-I 22— <br />....1 <br />F— <br />-4. <br />IS. International Shipments <br />Import to U.S Il Export from U.S Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U S.: TRANSPORTER 16. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Printed/Typed Name re Month Day Year <br />B ill4-11—e‘14 S l 1,„......:., ., e 2-1 2 ,N. I I I -2- <br />Transporter 2 Printed/Typed Name Signature Month Day Year <br />I I I I 4--- DESIGNATED FACILITY --* 17. Discrepancy <br />Discrepancy Indication Space Elill Quantity 0 Type Residue Partial Rejection Full Rejection <br />Manifest Reference Number: <br />Altemate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility (or Generator) Month Day Year <br />I I <br />18. Designated Fadlity Owner or Operator tertata covered by the manifest except as noted in Item 17a <br />Printed/Typed Name 1 Signature <br />\ <br />A <br />6 NHM-C-C-11 <br />1DESIGfIATED FACILITY TO DESTINATION