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Presse prim or type <br /> (Porta designed for use on elite It 2-ptch1 typewnrer <br /> iT <br />' KION-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n/a 0001 lOf 1 <br /> 3 Generators Name and Marling Address <br /> i <br /> rcheveron <br /> hw 12 /4 Generators Phone Ca <br /> 209 ) 467-3006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter <br /> rr, 7 Transporter 2 Company Name a US EPA ID Number B Transporters Phone <br /> M' <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> inviro tec <br /> 2480 ath <br /> ens ave. ,f <br /> lincoln, ca 95648 n a <br /> 11 Waste Shipping Name and Desenption 12 Containers T al Unit <br /> ' No I Type Quantity WWol <br /> a non haz waste liquid nos 2000 <br /> ;n <br /> waste water <br /> k G b <br /> r � E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> r { R L <br /> h d <br /> rD Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from poly holding tank <br /> r <br /> 15 Special Handling Instructions and Additional Information <br /> emg # abco <br /> troy w. 916-826--3803 <br /> { <br /> 16 GENERATOR'S CERTIFICATION 4 certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> Printed/Typed Name Signature Month Day Year r <br /> r� <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> rS n{ecaped a Si a re Month Day Year <br /> P ` O <br /> OR 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> r E Printed/Typed Name Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br /> rF <br /> A <br /> C <br /> 20 Facility Owner Operator Certification of receipt of waste materials c' -15 vered by this manifest except as note 19 f <br /> r y T <br /> Y � Year <br /> i�nnt G ame urs <br />' Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12198 <br /> Neenah WI 54957-W68 ORIGINAL,- RETURN TO GENERATOR <br />