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Pk�sse print or type <br /> (Poria designed foruse on etlte(12-pfthI,typew rdOT) <br /> NON-HAZARDOUS 1 Generator's US EPA ID NoManrfest Doc No 2 Pagel <br /> WASTE MANIFEST n/a 00001 lc 1 <br /> IQ 3 operators Name and Mailing Address <br /> F, cheveron <br /> hwy 12 lode , ca r <br /> 4 Generators Phone( 209 ) 467-1006 t im <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone e" <br /> thrifty rooter n/a 673-8201 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> r <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> w <br /> inviro tec u <br /> 2480 athen ave <br /> " lzncoln, ca Tl/a 434-0211 <br />' 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description v <br /> Total Unit <br /> No Type Quantity WWoI <br /> a non haz waste liquids nos 001. tt <br />'0 tanko � <br /> E b barrels 001 tt <br /> N <br /> s R Itt tS `d" <br /> A c <br /> TO <br />' R d <br /> tD Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from drums and barrels <br /> 15 Special Handling Instructions and Additional Information <br /> temg // abco <br /> troy w 916-826-3803 <br /> y <br /> 16 GENERATOR'S CERTIFICATION I cerlify the materials desenbed above on this marnfest ara not subbed to federal regula4ons?or reporting proper disposa3 of Hazardous Waste L - <br />' w Pnntedffyped Name Signature Month Day Year <br /> i <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br />' a <br /> Aid Nar� _ Si a r� Month Day Year <br /> N ���flCIC ! d <br /> S <br /> P <br /> O 18 Transporter 2 Acknowiedgement of Receipt of Materials <br /> R <br /> TE Printe(PTyped Name Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br /> 1 F <br /> A <br /> C <br /> Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> 7270Factlity <br /> nnted(Typed Name Signature Month Day Year <br /> BILL ARTAMENKO 17 1 21 QQ <br />' Printed by J J KEI I ER&ASSOCIATES INC 12-BLS-05 ReV 12/98 <br /> Neenah wl 54957-0368 ORIGINAL-- RETURN TO GENERATOR <br />