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Please Arent or <br /> (Form designed or use elite(72 pi6ch)typewrRer <br /> 4 NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> HASTE MANIFEST n a 00001 1 °f 1 <br /> 3 Generator's Name and Marling Address <br /> cheveron <br /> hwy 12 // lodi , ca <br /> r 4 Generator's Phone( 209 )467-1006 tin, <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n/a 530-673-8201. i <br /> �' 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone <br /> 4 yT 5 <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br />' inviro tec h ' <br /> 2480 athens ave . <br /> h lincaln, ca n/a 434-0211 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit r, <br /> No I Type Quantity WVVol +, <br /> anon haz waste liquid nos 'f <br /> waste water 001 ft 000 cia1, <br /> G b <br /> E <br />' N r <br /> " E <br /> R <br /> µ, <br /> k T c <br /> O <br /> R CDd.:".al <br /> " <br /> Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tanks <br /> 1 ` <br /> r <br /> 15 Special Handling instructions and Additional Information <br />' emg // abco <br /> troy w. 936--826--3803 <br /> 1 ' <br /> Sc <br />' Y 16 GENERATOR'S CERTIFICATION I certify the matenals described above on this manifest are not subject to federal regulations for reporting proper disposal at Hazardous Waste <br /> Printed/Typed Name Signature Month Day Year <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br />' R — <br /> A pnntedlTyped Name Signat re Month Day Year <br /> P BOB F00ETTY <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br />' E Pnnted/Typed Name Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> Fility Owner or operator Certification of receipt of waste materials covered by this manifest except-as noted in Item 1 <br /> 17jPar <br /> nntedrTyped Name 5 re" — i f Month Day Year <br /> y` <br /> 7 — <br /> Printed <br /> moPrinted by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12198 <br /> Neenah Wt 54957.0369 ORIGINAL- RETURN TO GENERATOR <br />