Laserfiche WebLink
Please pnntortype <br /> (Farm designed for use ort elite(t2�itch)tyi wr[ter) <br />' NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc Na 2 Pagel <br /> ALI WASTE MANIFEST nZa 10001 1 °f <br /> 3 Generators Name and Mailing Address <br />' cheveron 4_ <br /> hwy 12 lode , ca *Y <br /> 4 Generators phone( 209 ) 7 <br /> 5 Transporter i Company Name 6 US EPA ID Number A Transporters Phone <br /> �r <br /> thrifty rooter - <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> �xri x <br /> x� rz <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> t; znvzro tec n/a 434-0211 <br /> 2480 athens ave. f, <br /> � lin.coln ca ' <br /> f <br /> 11 Waste Shipping Name and Description 12 Containers 7 Eal Unit <br /> 14 <br /> No Type Quantity Wt/Vol <br /> a t' <br />' non haz waste liquid nos 001 tt 4000 gal.,,, <br /> f G b L <br /> x�. <br /> N' E <br /> N <br /> E r <br /> R <br /> A c Y <br /> T <br />' R d <br />� ^ D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> 15 Special Handling Instructions and Additional Information <br /> 1� emg troy w. // abco 916-826-3803 <br /> 16 GENERATOR'S CERTIFICATION I certify the matenals descnbed above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> Pnntedfryped Name Signature Morth Day Year <br /> 1 <br /> 17 �nspore,1Acknowle nt of Recei t 1 gals <br /> Pnedrryped Name I Si nature Monro Day Year <br /> P e 7-ti 00 <br /> O 18 Transporter 2 Acknowledgement of ecept of Materials <br /> T Printedlryped Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy indication Space <br />' F <br /> A <br /> C <br /> 20Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Y <br /> PnntedlTyped Name Signatur '� Month Day Year <br /> c � 17J1 bo <br /> Pnnted by J J KELLER 8 ASSOCIATES INC <br /> Neenah WI 54057-MBS ORIGINAL <br /> Rev 1219$ <br /> ORIGINAL- RETURN TO GENERATOR <br />