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Pleasa print or type <br /> (Form designed for usa an elite(12-pitch)typowi6er) <br />' NON-HAZARDOUS 1 Generator'S US EPA ID No Manifest Doc No 2 Page f <br /> WASTE MANIFEST n/a 001 1of 1 <br /> 3 Generator's Name and Mailing Address <br /> chevexon <br /> hwy 12 lode , ca <br /> 4 Genefator's Phone( 209-467-1006 t 1 m <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n a 673-1923 <br /> 7 Transporter 2 Company Name a US EPA ID Number 9 Transporter's Phone <br /> e <br /> i3 <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> inviro tec <br /> 2480 athens ave . ai <br /> kr� <br /> ^F lincoln, ca 95648 n a 434-0211. <br /> 13 14 <br /> :s 11 Waste Shipping Name and Description 72 Containers Tonal Unit <br /> No Type Quantity Wt/Vol � <br /> a /s non waste lzgtxld nos <br /> rf waste water <br /> G b <br /> E <br /> � N <br /> E <br /> R <br /> w A c <br /> a T <br /> O <br /> R <br /> A <br /> d <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> waste water from poly holding tank <br /> I * <br /> 15 Special Handling Instructions and Additional Information <br /> emg # abco <br /> troy w 916-826-3803 <br /> 14� <br /> 16 GENERATORS CERTIFICATION I certify the materials described above on this manifest are not subject to federal regolattons for reporting proper disposal of Hazardous Waste <br /> Prmted/Typed Name Signature Month Day Year <br /> 17 sparter 1 AcknowledgelMVt of Receipt of Materials <br /> R <br /> Pnn d/Typed Name ~ gay Ye r <br /> P f\. <br /> d 18 Transporter 2 Acknowledgement of eceip of Materials <br /> R <br /> _ E PnntediTyped Name Signature Month Day Year - <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> E20Facillty Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted In Item 19 <br /> Yrryped Name Signature D <br />' Pnnted by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 2/98 <br /> Neenah WI 54957-0.968 ORIGINAL- RETURN TO GENERATOR <br />