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Please pfhit or type <br /> (Form deslgned for use 11111ell0e 112-pftr;h)typewriter) y <br /> NONHAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 s <br /> WASTE MANIFEST n/a 0001 101 1 <br /> 3 Generator's Name and Mailing Address <br /> cheveron <br /> I ; <br /> hwy 12 // lode. , ca tzm <br /> 4 Generator's Phone(209 } 467 1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n./a 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 />' znviro tec <br /> 2480 athen aver <br /> lincoln, ca 95648 n a 434-0211 <br /> V 13 14 <br /> 11 Waste Shipping Name and Descnption 12 Containers Total Unit , <br /> w� <br /> No Type Quantity Wt/Vol <br /> a non haz waste liquid nos 001 tt 3000 gala'2 <br /> 4- 'N <br /> i„ G b <br /> E <br /> s" N <br /> - E <br /> R <br /> N A c <br /> m T <br /> R <br /> 6 � <br /> d <br /> 1 D Additional Descriptions for Matenals listed Above E Handling Codes for Wastes listed Above <br /> t ' <br /> S <br /> purge water from tank `w <br /> x 15 Special Handling Instructions and Additional Information <br />' eR5tx!UL51XXXXX <br /> troy w. 916--826-3803 <br /> 3 � <br /> 16 GENERATOR S CERTIFICATION I certify the matenals Qescnbed 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 /> R <br /> SI Month Vay Year rr <br /> Pnnted/Typed Name 9 <br /> N bill artamenko 7-12 00 <br /> P <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> TPnniedrryped Name Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> A ohm. <br /> �720Facility Owner or Operator Certification of receipt of waste matenals covered by this manifest except as noted Item19 <br /> Pr <br /> Name Signature Month Da Year <br />' Printed by J J KELLER 8i ASSOCIATES INC 12-BLS-05 Rev 12198 <br /> Neenah Wl54,a57-0368 ORIGINAL-RETURN TO GENERATOR <br />