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Please ppdrtm ar <br /> (Form designed ar use on eMe(12-pith)typewriter) <br />' NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> fF WASTE MANIFEST n/a 0001 1°f 1 <br /> 3 Generators Name and Marling Address <br /> cheveron lodz <br /> zx hwy 12 tim <br /> 4 Generators Phone( 209 4 6 7-10 0 6 <br /> 46 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br />' thrifty rooter n/a 673--1923 <br /> r 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 Phone w <br /> inviro tec <br /> z;a 2480 Athens <br /> lincoln ca 95648 n/a 434-0211 <br />' 3 14 <br /> 11 Waste Shipping Name and Description 12 Containers Total Unit v <br /> "t No Type Quantity Wt/Vol <br /> anon haz waste liquid nos 001 tt <br /> waste water <br /> G b <br /> E <br /> IN <br /> r R <br /> A c <br /> T <br /> 1 C R <br /> d <br /> 4 <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> 15 Special Handling Instructions and Additional Information <br />' emg abco <br /> 916-826-3803 <br /> troyw. <br /> 1 <br /> 1 h i <br /> f <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 /> PrintecliTyped Name gnature Month Day Year t <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br />' N nntedlTyped 1�fa Sint Month Day veer <br /> 9 I 1 <br /> P <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> E Printed/Typed Name 5rgnature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> k 20 FEOWnerperator Certification of receipt of waste materials covered by this manifest except as noted in Item <br /> Y e a Day Year <br /> PmeBIMENK0 <br />' Printed byJ J KEUER&ASSOCIATES INC 12-BLS-C6 Rev 12198 <br /> Neenah WI 54957-0368 ORIGINAL- RETURN TO GENERATOR <br />