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r <br /> Please pprint artype <br /> (Bonn desgned for use on elite{12-Pirochl typewriter! <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n at <br /> 3 Generators Name and Mailing Address <br />' cheveron lode <br /> 7 hwy 12 <br /> a Generators Phone( 4 6 7 f 10 0 6 <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 8 US EPA ID Number 8 Transporters Phone <br /> vL <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone w <br /> inviro tec <br /> 2480 athens ave =e= <br /> Lincoln, ca 95648 434-0211 <br /> 11 Waste Shipping Name and Description 12 Containers 13 s <br /> Total Unit ' <br /> k` No Type Quantity Wt/vol <br /> 114 1 <br />' anon haz waste water nos <br /> Taste waterr <br /> Ool tt <br /> Yx <br /> rpG b <br />' E t <br /> N <br /> E <br /> R <br /> A c <br /> T <br />' aR <br /> . R <br /> d <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water fom poly tank <br /> a <br /> 1 <br /> 15 Special Handling Instructions and Additional Information <br />' emg troy / abco/ 916-826-3803 <br /> 16 GENERATOR'S CERTIFICATION I 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 <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br />' R <br /> N <br /> nt d7yped Name Ss tur loon Day Year <br /> P t �� <br /> O 18 Transporter 2 Acknowledgement of Receipt of Matenats <br /> R <br />' E Pnnted(fyped Name Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> LFacifityr or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> d Name a r Mo th Day Year <br /> __­=- — .4LJ <br /> AIRITAMBNKe <br /> Pnnted by J J KELLER 8 ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI 54957-0368 ORIGINAL- RETURN TO GENERATOR <br />