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I <br /> Please print ar type <br /> (Form designed for use gt elfte(12-pitch)4pew ffl-) <br />' NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n a 0Q01 of <br /> 3 Generators Name and Marling Address <br />' Y cheveron <br /> lodx , ca <br /> 4 Generator's Phone( 209 ) 467-1006 TIM <br /> 7j 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> 'r3 a <br />' Kn thrYfty 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 10 Number C Facikty s Phone <br /> ivniro tec <br /> 2480 athens ave . <br /> lincoln <br />' 12 - on iners 13 14 rLA 11 Waste Shipping Name and Description Total Unit <br /> No Type Quantity Wt/Vol <br /> a <br /> I = non haz waste water 001 tt <br /> ti^ � <br /> b n <br /> I N <br /> R <br /> v <br /> A c <br /> T <br /> O <br /> R <br /> 'v I 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 /> Iemg contact /// abco troy w. 916-826-3803 <br /> 4 <br /> 1 <br /> 16 GENERATOR'S CERTIFICATION I certify the matenals described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br />' r Pnnted/Typed Name Signature Month pay Year ' <br /> TR 17 Transporter 1 Acknowledgement of Receipt of Materials <br />' A ted/ry[(jpB me Si a Month Day Year <br /> SS f i 4'l r o <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> I TPnnted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> I <br /> 20 Facility Owner or operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> IY Pnnted/Typed Name Sign - Monrh Day Year <br /> BILL ARTA d <br />' Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12/9$ <br /> Neenah WI 54957-0366 ORIGINAL- RETURN TO GENERATOR <br />