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Please pnot or I <br /> ype <br /> (Form designed +rse an elite(12 pitch)typerrtlter} <br />' NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> TWASTE MANIFEST of <br /> 3 Generators Name and Mailing Address <br /> a <br />' A{4 cheveron <br /> hwy 12 // lodz , ca tzm <br /> 4 GeneratorsPhone(209 ) 467-1006 ; <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br />' N <br /> thrifty rooter 530-673-8201 <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 /> 1 �} y <br /> inviro tec <br /> 2480 athens ave <br /> llnco n/a 434-0211 , <br />' 13 14 <br /> 11 Waste Shipping Name and Description 12 Containers Total Unit <br /> No I Type Quantity wwol <br /> � a <br /> non haz waste liquid nos 00 tt 3000 ga <br />' waste water <br /> �. G b <br /> IJ <br /> z E <br />' 3M1c N <br /> r R <br /> A c <br /> T <br /> z O <br />' R <br /> d <br /> ,Y <br /> D Additional Descriptions for Materials Listed Above E Handling Godes for Wastes Listed Above <br /> purge water from tank <br /> 15 Specal Handling Instructions and Additional Information <br /> emg // abco <br /> t troy w. 916-826-3803 <br /> 16 GENERATOR'S CERTIFICATION I certify the materials described above on this manifest are not subject to federal regulations for repoding proper disposal of Hazardous Waste <br />' Pnnted/Typed Name Signature Month Day Year <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed Name Signature Aly Year <br /> S BILL ARTAMENKO ; <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br />' rPnnted(Typed Name Signature Month pay Year <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> rPrinted/Typed <br /> cility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br />' Y <br /> Name Signature onth Day Year <br />' Printed by J J KE Rs KO 12-BLS-05 Rev 1219& <br /> Neenah W154957-6368 ORIGINAL- RETURN TO GENERATOR <br />