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Ple&se print ar type <br /> (Form designed for use on elate(12-pfth)tAwwrder k <br /> NON-HAZARDOUS 1 Generators U5 EPA Ip No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n/a 0000.1 1 of 1 <br /> 3 Generators Name and Mailing Address <br /> Cheveron lode. , ca ` <br /> hwy 12 <br /> 4 Generators Phone( 206 ) 467-1006 tim <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter n/a 673-1923 <br />' 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> r <br />' 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone { <br /> znviro tec <br /> 2480 athens ave <br /> ' lincoln, Ca 95648 n/a 434-0211 <br /> - 11 Waste Shipping Name and Description 12 Containers 13 <br /> Total Unit <br /> No Type Quantity Wt/Vol <br /> a <br /> non haz waste liquid nos 001 t <br /> waste ua.ter1 <br /> G b <br /> A E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> I a R <br /> d <br />' D Add4ional Descriptions for Materials Lasted Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> 15 Special Handling Instructions and Additional information <br /> 4 emg troy <br /> abco 916-826-3803 <br /> 16 GENERATOR'S CERTIFICATION I certify the materials described above on this manifest are not subject to federai regulations for reporting proper disposal of Hazardous Waste <br />' PnntedlTyped Name Signature Month Day rear 2 <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br />' R Sr r Month Day Year <br /> An ed/TypedNamer <br /> A 18 Transporter 2 Acknowledgement of Receipt of Materials <br />' T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> 20 Facility Owner or Operator Certification of receipt of waste matenais covered by this manifest except as noted g1tern, <br /> t Y 7Z <br /> C o Oa rear <br /> Pnnied/Typed Name Si <br /> BILL ARTAMENKO <br />' Pnnted by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12198 <br /> Neenah WI 54957 0368 <br /> ORIGINAL-- RETURN TO GENERATOR <br />