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Please jxmt <br /> (Form designed faarrortype <br /> use elite(12-PFtch)tYPr <br />' NOWHAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST n/a 0001 1 of 1 <br /> 3 Generator's Name and Mailing Address <br /> cheveron <br /> hwy 12 // lodl , ca <br /> v 4 Generator's Phone( 209 ) 467-1006 att :tlm <br /> _7 ' <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n a 916-673-8201 <br />' 7 Transporter 2 Company Name 8 US EPA ID Number 8 Transportel's Phone <br /> i <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone <br /> lnvlro tec <br /> °?d 2480 athens ave n/a 434-0211 <br /> f , lincol.n, ca 95648 ry <br /> r 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description <br /> � Total Unitx <br /> No Type Quantity Wt(Vol <br /> a <br /> non haz waste liquid nos 001 tt 3000 Baal <br /> waste water r�0e) <br /> G b <br /> E <br /> NL <br /> n N 3 <br /> R <br /> A c <br /> 7 O <br />' ¢ R <br /> d <br />' D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> 15 Special Handling Instructions and Additional Information <br /> s <br /> r' emg abco,] troy w. 916-826-3803 <br /> 16 GENERATOR S CERTIFICATION I certify the materials described above on this manifest are not subject to federal reguiattons for reporting proper disposal of Hazardous Waste <br />' F PnntedfTyped Name Signature Month Day Year <br /> I <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> Nt�d/Typed Na S+gn Month Day Year <br /> P Mr.c GC v � �-!�� did <br /> O 1 B Transporter 2 Acknowledgement of Receipt of Matenals <br /> E' Pnnted(Typed Name Signature Month Day Year R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> I <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Y <br /> Pnntet �ld ame nature Monro Day Year <br /> � artamenko T7- -2 <br />' Printed by J J KELLER&ASSOCIATES INC <br /> Neenah WI 50.957,0368 ORIGINAL <br /> Rev 12198 <br /> ORIGINAL-RETURN TO GENERATOR <br />