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(==r.use on elite(i2llilch)t}rpevrriGer) <br /> i NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> HASTE MANIFEST 1n/a 00001 1 of 1 <br /> 3 Generator's Name and Mailing Address <br /> Cheveron <br /> i ryp hwy12 / loch. , ca ' <br /> a 4 Generators Phone( 209) 467 1006 t:LM <br /> a - <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br />' thrifty rooter n./a 530-673-8201 <br /> 7 Transporter 2 Company Name B US EPA ID Number 8 Transporters Phone <br /> •� 1 <br />' 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> znviro tec <br /> 2480 athen ave. <br /> lincoln, ca 95648 n/a 434-0211 <br /> x 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Tota! Unit <br /> No Type Quantity WWoI t <br /> a non haz waste liquid nos 001 tt 3000 ga ' <br />' waste water <br /> YL <br /> G b <br />' E <br /> N <br /> E <br /> R <br /> A c <br />' R <br /> d <br />' D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> i <br /> purge water from tank <br /> V <br /> 15 Special Handling Instructions and Additional Information <br />' = r emg // abco <br /> troy w. 916-826-3803 <br /> I <br /> r <br />' r 16 GENERATOR'S CERTIFICATION 1 certify the matenals described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> Printed/Typed Name Signature Month Day Year <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br />' APrinteOTyped Name Signature myon D Year <br /> p BILL ARTAMENKO <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials <br />' T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> Ad 11110� <br /> 20 Facility Owner or Operator-Certification of receipt of waste materials covered by this manifest except noted in Item 19 <br /> P <br />' T <br /> Y nnted/Typed Name 5iria#ure 9 a <br /> Mo Dam_Year <br /> BILL ARTAMENK0 <br />' Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI 54957-W68 ORIGINAL- RETURN TO GENERATOR <br />