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' <br /> Please print or type <br /> {Form destgrred for use on elite(12-pdch)type-niter) <br />' NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n a 10001 1 of <br /> 3 Generator's Name and Mailing Address <br /> cheveron <br /> h1?y12 , lodi , ca <br /> a Generators phone(209 ) 467-1006 " <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> inviro tec n a 434-0211 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> 9 Designated facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br />' inviro tec <br /> 2480 athens ave. <br /> lincoln, ca 95648 n a 1 4-0211 <br />' 11 Waste Shipping Name and Descnption 12 Containers Total aol 14 <br /> Unit 'E <br /> 'A No Type Quantity Wt/vol , <br /> a non haz waste liquid nos 3000 <br /> 001 tt c- <br /> r; waste water <br /> G b <br /> N <br /> R <br /> A c v <br /> °r T <br /> O <br /> R Y 4 <br /> d <br /> All <br />' D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Abave <br /> purge water from tank <br /> 15 Special Handling Instructions and Additional Information 1 <br />' emg # ABCO <br /> TROY W.1f1,f1fV3 $X1$1 826-3803 <br /> I <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 " v <br /> PrintedlTyped Name Signature Month tray Year <br /> TR 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> IAted/Typed Na Slg ur Month Day Year <br /> P 1 ?f j <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br />' PnntedlTyped Name Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> 20 Facility Owner or Operator Certification of receipt of waste matenals covered by this manifest except as noted in Item 19 <br /> Y Day Year <br /> fe ped Name S f <br /> Printed by J J KELLER&ASSOCIATES INC 12-BLS-C6 Rev 12/98 <br /> Neenah WI 549570368 ORIGINAL- RETURN TO GENERATOR <br />