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1 � - <br /> PEease Print pr tea <br /> (Form destgrred for use on eine(12 p +)typewriter) <br />' NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST of <br /> 3 Generators Name and Mailing Address <br /> Cheveron - ° <br /> lode hwy 12 tim <br /> 4 Generator's Phone(209 ) 467 1006 <br /> - 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter n/a 673-8201 ` <br />' 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone <br />' 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facilitys Phone v <br /> invxro tec <br /> s480 athens ave <br /> Lincoln, ca 95648 n/Et 434-0211 <br />' Y 11 Waste Shipping Name and Descnption 12 Containers 13 14 <br /> TotaU <br /> I nit <br /> No Type Quantity Wt/Vol <br /> a non haz waste liquid nos 001 tt 2000 gal ,,' <br />' waste water T_ <br /> G b <br /> Ew <br /> N <br /> A c <br /> T <br /> O <br />' R d <br />' ❑ Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> 1 <br /> R <br /> 15 Special Handling Instructions and Additional Information <br /> x <br /> c <br /> i <br /> r <br /> r� s <br /> d16 GENERATOR'S CERTIFICATION I cert,,,,the materials described above on lhis manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br />' r Pnnted/Typed Name Signature Month Day Year <br /> T 17 sporter 1 AcknowleggWent of Receipt of Materials <br />' A Pn d] iKA KO S nat , Month Day Year <br /> s 7- 4 00 <br /> O 18 Transporter 2 Acknowledgement f Receipt of Materials <br /> TPnnted/Typed Name Signature Month Day Year <br />' E <br /> R <br /> 19 Discrepancy Indication Space <br /> 1 F <br /> A <br /> C <br /> 2O Facility Owner or Operator Certification of receipt of waste matenais covered by this manifest except as noted in Item 19 <br />' I <br /> Pnnted/Typed Name Signai � Month Dov Year <br /> u <br /> —L ARTAMENKO 1-1—i <br />' Pnnted by J J KELLER tf ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI 54957 0366 ORIGINAL- RETURN TO GENERATOR <br />