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Please Print ortype <br />' {Form designed for eae on.1118(12-pilaf)typewriter) <br /> NON-HAZARDOUS t Generator's US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST n/a 0001 1 of 1 <br /> 3 G=enerators Name and Malting Address <br /> cheveron <br /> hwy 12 <br /> // 1 o d 1 , e a <br /> 4 Generators Phone( <br /> 209 467 1006 tim <br /> 5 Transporter 1 Company Name & US EPA ID Number A Transporters Phone <br /> thrifty rooter <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> . z <br />' ,4 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone <br /> 1nviro tec <br /> z 2480 athen save <br /> x <br /> lzncoln ca 9564 _ <br /> N 11 Waste Shipping Name and Description 12 Containers 13 14 , <br /> Total Unit <br /> M No Type Quantity WWol <br /> r , <br /> a non haz waste from drums jos 001 tt 3000 gal <br /> x� <br /> waste water - <br /> 1_ G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> h R <br /> J- <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from xxx tanks <br /> 15 Special Handling Instructions and Additional Information <br /> emg // abco <br /> troy w 916-826-3803 <br /> 1 t, <br /> 16 GENERATORS CERTIFICATION I certify the matenals described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> t Printed/Typed Name Signature Month Day Year <br />' T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A <br /> N Pnnted(ryped Name Signature Month Day Year <br /> SBILL ARTAM-ENK0 <br /> P — — <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials <br />' T Pnnted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> 20) Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as not <br /> in item <br /> T <br /> Y <br /> Pnnte67yped Name Sign Day ar <br />' Printed by J J KELLER 8 ASSOCIATES INC ' 12-BLS-05 Rev 12198 <br /> Neenah WI 54957-0388 ORIGINAL- RETURN TO GENERATOR <br />