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Please pnntarlvpe <br /> (Porto Ig 1 or use nn eMe(I2-pfth)typetvriter) <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n/a 0001 1 a 1 <br /> 3 Generators Name and Mailing Address <br />' Cheveron j <br /> hwy12 // oldi , ca 3 <br /> 4 Generators Phone( 209) 467--1006 tial r'k <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter n/a 916-434-0211 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone , <br />' xnvzro tec n/a 434-0211 <br /> 2480 athens ave . <br /> lsncoln, ca 95648 <br /> 13 14i <br /> f 11 Waste Shipping Name and Description 12 Containers Total Unit b <br /> No Type Quantity WtlVol T <br /> a F <br /> non haz waste liquid nos 001 Itt 3000 al nk <br /> waste water <br /> c G b <br /> ;< <br /> E <br /> N <br /> R <br /> A c <br /> T <br /> 1 e O <br /> R <br /> d <br /> z <br />' 'I I PF D Additional Descriptions for Materials Listed Above E Handling Codes far Wastes Listed Above <br /> purge water from tank <br /> 15 Special Handling Instructions and Additional information <br /> r , <br /> emg / abco <br /> t troy w. 916-826-3803 <br /> 1 <br /> 3 <br /> 16 GENERATOR'S CERTIFICATION I cernty the materials described above on this manifest are not subject to fade al regulations for reporting proper disposal of Hazardous Waste <br />' Pnnted(Typed Name Signature Month Day Year <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name th Ray Year <br /> P BILL ARTAMENKO 7 5 100 <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> T Pnntedrryped Name Signature Month Day Year <br />' E <br /> R <br /> 19 Discrepancy indication Space <br />' F <br /> A <br /> C <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as n in Item 19 '] <br /> Y <br /> PnntedlTyped Name Signat /y N � Month Day Year <br /> CJ <br />' BILL AIRTAMENK0 <br /> Printed by J J KELLER$ASSOCIATES INC <br /> 12-BLS-05 Rev 12/98 <br /> Neenah WI 54957 0368 <br /> ORIGINAL- RETURN TO GENERATOR <br />