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07!1312000 15 35 4089421499 1 PAGE 02 <br />I1' 4[] 44! iJ4��y jun 2u-uu b LliltlYly 0jc <br />aserjet e1uu, <br />r <br />OIL. Republic ServrceS <br />Vasco Road Landfill <br />WASTE APPROVAL FORM/NON-HAZARDOUS WASTE MANIFEST <br />WASTE STREAM INFORNUTION <br />i <br />I <br />Date Wcdn�sday, J1m4 2R, 2i1Do <br />eratur Chevron t�9-4775 <br />Generator Location 301 Wert Ketticman 1 �► <br />IT odt t_ 9 <br />vwm—herOZlii l <br />I� <br />To 1WM <br />Approval Date 61z814t0 <br />! �l 6128!01 <br />31 Eaptr�tlon Date <br />f€' lionaen{cat <br />ADC. <br />�' Thr eb4vP r. u rtCattlttlCaflallr:R Ajthe { adrn har.rl LandfflL It mu•r or undcnt ro�dl u Ea9 'll u` ore u re Ic'4' rlf h for <br />lnfrdrmutatr pat ravbIhrQ b tkr Relator <br />E IJlf j+7ultq `� permit errd upnLea�!¢ jtdera! stun dad local "gulurrnnc rhe !l1?p content ro cfirmlca! rnmprr+kion and 10 "d Proper!)" 'Olt' <br />r and n mmiingent apron the recelJ1f ar the AW(Au(jRtift(1 ofd "rwfr n+atrrra! et,EarroflJ rq4 <br />I i as rleflnrd abo►r <br />MINlhf1/MOI 0J4� 31fiNf.A aA'D CoMp! F I ED CDT } OF I HIS FORM Af [!11 ACC01{fP4,% 1 P-,4 C17 MID Un'r ( UPY WILL BFR RE AINI<D <br />I!Yr11 VAVfJN(JJVLANDFILL <br />30 2'TozD <br />Dal► <br />(�encrator �tgna[t{rt: <br />TRANSPORTER INFORMATION <br />�r l 11<ntporter to rnmplele this suttin <br />s ransporter Name <br />Trawsporter Adnress <br />frpasporter City, State, Zip <br />Transporter Prone Numbcr <br />rD-rimer Name <br />Track 14umber <br />Vehicle License liumberfStatr <br />in#egrated Wastestream Management, Inc <br />950 Ames Avenue <br />Mjjpitas, CA 95035 <br />(408) 942-8955 <br />Bill Penn <br />1111113 <br />9423690 <br />Driver Signature <br />DESTINATION INFORMATION <br />mdtertar has bkt q accepted riad In she he%T nlmY 1LO%led Or <br />YY that Ehc alwvc Hamid e <br />i <br />!late <br />t{tg as true Abd ace+sritt[,_ <br />^� Tlate <br />SrgtlatUTC of IV aico Road 1 Andfdl employee <br />J!N}t North Vasco Road LA,.crnrorr - runttt 925-447 (1691 -) a1 y:5-s47--W8s3 or 925-4a7-04" <br />