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07/24/2000 11 10 4089421499 I <br />- _aseriel jluu, •322 441 U4Y93 jun ,b -uv n U4e.M, <br />_, � Republic Services <br />P% Vasco Road Landfill <br />PAGE 02/02 <br />r202 1 <br />WASTE APPROVAL FORMINON-HAZARDOUS WASTE MANIFEST <br />WASTE STREAM INFORMATION <br />,Elate Wednesday, Julie 2R, 2000 <br />r�e1t4t8tor Chewon 09-5775 <br />! e_rator Location 301 West Kerfleman I n l,udl t A <br />vu,nber 02611 <br />r, IWM <br />,xproval Date 6/28/00 <br />IEsptra[ion Hate 6128/01 <br />Waste llcct rrptton Soil GY <br />"(Kna�etltcut kDL <br />The abase n ufetdmmrnrtalerrn ofrhe i asm K,rud Landfill Ir,—%, - allat rr,oud'hat maly479fmr'r0 tJ rhv wa,rr fur diapncal xrw3r bt 1., (-nrrtf Ort- lrh <br />rhe %avh4, t permlr and applrrsblefederal, �tdlf' and lata! rrgularrwxs The appruvul m bust d>'pou a re,lew of tht tafnrrnarum prv6laed A the 4rmri ,jot <br />and r, cuMingenf Ws;j the reCe lir 111:ho dr+pa5al fa411jr6 Of x ri37e m(Ulrlal [+*C,rerrrll) t 9urvalernr ra �4,emlr4t rnmpn,rrrWr and pht­no; prnperile$ fG thur <br />u, rtefrned nbnvt <br />AmpyiAlliirOroAESl(vv-DAKDCOMpIFIEDCOPtO> r'x!S!-ORM All INIACCOMP4%) t-A('11LO11) unr (Jr?r"ILL RFRtIif -ED <br />81 THE rrA 5 r o No 1,U LA vn FILL <br />- f,eucratar Signature Datt <br />TRANSPORTER INFORMATION <br />Tl an %portEr to complete tht5 scrttin <br />an5porter Name <br />'1:ran%purfer Add tess <br />Transporter City, State, Z►p <br />�_ansuortcr Phone Nalriber <br />"- -r N aMe <br />Truck Number <br />Vehicle License Number/Stat' <br />Integrated Wastestrealn Management, Inc <br />950 Ames Avenue <br />M11pitas, CA 95035 <br />(408) 942-8955 <br />Bill Penn <br />1111113 <br />9423690 <br />D (ver Signature <br />DESTINATION INFORMATION <br />ti cast thr ahn.t named rrrxteriar h&6 br..o accepted Rod to ti,r heat of my orC <br />Date <br />lA true Ll 041 jMIrdlt <br />�7 r <br />Signature of Vasco Road Landril1 %mPInyee Date <br />16001 ,North Vasco. Rood Lrrrrnrorr - Vhonr 92144741491 - ryx 91';.4-17-1006 ar 92r,"7-41399 <br />