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NON - HAZARDOUS WASTE MANIFEST <br /> r <br /> PROFILE NO 0 P)'65 pt-800 11908 <br /> -458-3636 <br /> ❑ BAKERSFIELD ❑ YOLO ❑ PHOENIX <br /> NOTE This form to be in lieu of the Toxic Substance Controls hazardous <br /> waste manifest To be used for NON-HAZARDOUS WASTES only <br /> Name ARC ` <br /> ix <br /> 0 Mailing Address �c�.l_1_y�tin� �tiGe Lid <br /> a <br /> ZCity/State/Zip 'ti l Cc&, <br /> W <br /> C7 Phone No Contact <br /> M Signature Date <br /> D <br /> j F G <br /> THE ENE ATOR CERTIFIES THAT T ASTE AS DESCRIBED 1S 100% NON-HAZARDOUS <br /> -� Waste Description MONITORING WELL SAMPLING <br /> a <br /> 0 Generating Location <br /> U <br /> Ul <br /> m Handling Instructions <br /> I O Quantity —_ C IBBL CX JGLS I I YDS C ]TONS <br /> CONTAINER TYPE E XITANK TRUCK I I DUMP TRUCK C I DRUMS E ]BINS C ]OTHER <br /> �E DESIGNATED FACILITY <br /> NAME SEAPORT ENVIRONMENTAI,,SERVICES ADDRESS 675 SEAPORT BLVD, <br /> CITY/STATE/ZIP REDWOOD CITY, CA 94063 PHONE # 650-164-8154 <br /> cc <br /> LU MP VACUUM TRUCK SERVICE TICKET# `d 17 X61 S TRACTITRLR# / <br /> Cr <br /> O MP ENVIRONMENTAL SERVICES, INC Bin No s <br /> i3_ 3400 Manor Street Signature <br /> € N Bakersfield, CA 93308 Date <br /> Q 805/393 1151 PIU DATE 4 t0 Job# <br /> E cc <br /> Name SEAPORT ENVIROLUENTAL SERVICES Disposal Method <br /> Address 675 SEAPORT BLVD_ El Landfill Other <br /> F- <br /> City/State/Zip REDWOOD CITY, CA,,,,,,94063 <br /> U <br /> Phone No _ 650-364-9154 _ Time am <br /> Q Discrepancy <br /> Pm <br /> I <br /> 6, <br /> E Signature Date / / <br />