Laserfiche WebLink
' Pleasepprint or h'Pe <br /> (Forrn rlesigried for use on elite(12#11ch)typewnter) _ <br />' IT-NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST na of <br /> 3 Generator's Name and Mailing Address <br /> cheveron <br />' hwy 12 lode , ca <br /> 4 Generator's Phone( 2091467-1QQ6 / <br /> x <br /> 5 Transporter 1 Company Name 6 US EPA fD Number A Transporter's Phone <br /> thrifty rooter n a y <br />' 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone <br /> 9 Designated Facility Name and Site Address 14 US EPA ID Number C Facility s Phone <br /> lnviro tec era <br />' 2480 <br /> �- athens ave . <br /> Lincoln, ca 95648 <br /> r 12 Containers 13 14 <br />' k* 11 Waste Shipping Name and Descnphon Total Unit w <br /> No I Type Quantity Wt(Vol <br /> a 2200 , <br /> non haz waste liquid nos r <br /> -, waste water <br /> G b <br /> E <br /> } N <br /> E i <br /> R <br /> A c <br /> T <br /> O <br /> R d j <br /> Y I <br /> J D Additional Descnptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> xr <br /> Purge water from holding tank <br /> '49 <br /> 15 Special Handling Instructions and Additional Information <br /> emg # abco <br />' h troy w. 916-826-3803 <br /> 1� <br /> 16 GENERATORS CERTIFICATION I certify the matenals described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> Pnnted/Typed Name Signature Month nay Year n <br /> a <br /> T <br /> R 17 Transporter 1 Acknowledgement of Receipt of Materials <br />' A � edRype Name Si ur Monro Day Year ' <br /> N /11 <br /> P 6r AID P <br /> OR 18 Transporter 2 Acknowledgement of Receipt of Materials <br />' T Pnnted/ryped NameSignature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy indication Space <br /> F <br /> A <br /> C <br /> ta <br /> rator Certification of receipt of waste materials covered b this manifest except as noted in Item 19 <br /> 1 na Day Year <br /> r <br /> Pnnted by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 1��� <br /> Neenah WI 54957-0368 ORIGINAL- RETURN TO GENERATOR <br />