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i <br /> Please ptHrt or � <br /> (Fvmt desrgnad fpr use on efts(12 pitch)typenntsr) <br />' NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n/a 0001 1 of 1 <br /> RIF3 Generator's Name and Marling Address <br /> cheveron <br /> hwy 12 lode , ca att : TIM <br /> 4 Generator's phone( @a ) ) ,¢ f 209-467=1006 M <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br />' y n/a 916-673-8291 <br /> 7 Transporter 2 ompany Name 8 U5 EPA ID Numbgr B Transporter's Phone k <br /> r � <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> znvzro tec n/a 434--0211 k <br /> rr 2480 athens ave <br /> lzncoln, ca 95648 <br /> 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description12 <br /> Unit ` <br /> No Type Quantity Wt/Vol " <br /> a <br />' ,4 non haz waste liquid nos 001 tt 3000 gal <br /> waste water -3 a a 0 ) <br /> G b .M <br /> E <br /> N <br /> ,. E <br /> R <br /> < A c <br /> T <br /> 1 # O 4 <br /> R <br /> t1 OF 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 /> emg ///albco <br /> r troy w. 916-826--3803 <br /> 1 J, <br /> 16 GENERATOR'S CERTIFICATION I certify the matenafs described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste G ` <br /> Printed/Typed Name Signature Month Day Year <br /> 1 ` - <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br />' R <br /> A 2ted/Typed Na Si a r Month Day Year <br /> S +f -.. )1 13 616 <br /> - <br /> P <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br />' n T Pnntedfryped Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> Y <br /> !20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br />' Pnnted/Typecf Name Signature ) anrh Day Year <br /> BILL ARTAMRNKO <br />' Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 1?J9$ <br /> Neenah w154957-0868 ORIGINAL- RETURN TO GENERATOR <br />