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Please print or type <br /> (Form designed for rue pn silts(12-00)typevaller) <br /> NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br />' - WASTE MANIFEST N/a 0401 10fl <br /> 3 Generators Name and Mailing Address <br /> cheveron lode , ca <br /> hwy 12 <br /> 4 Generators Phone(2 O 9 ) 467-1006 <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 /> I w <br /> t <br />'u n 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone <br /> >_nviro tec <br /> 2480 athens ave . <br /> lincoln , ca 95648 n/a 434--0211 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> ` Total Unrt <br /> Na Type Quantity WWol <br /> a <br /> non haz waste liquid nos <br /> waste crater 0101 tt � � 0'd <br /> G b <br /> E <br /> N <br /> E <br /> A c <br /> T <br /> 1 O <br /> R <br /> d <br />' 4101D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge waTER FROM POLY TANK <br /> 15 Special Handling Instructions and Additional Information <br /> emg /abco/ troy w. / 916-826-2803 <br /> 1 l £ <br /> v� <br /> 16 GENERATOR S CERTIFICATION I certify the matenats descnbed above on this manifest are not sublect to federal regulations for reporting proper disposal at Hazardous Waste <br /> �j <br /> Pnntedrryped Name Signature Month Day Year L <br /> T 17 Transporter 1 Acknowledgement of Receipt of Matenals <br /> R <br />' t dlTyped Nam Sig r f�a Month pay Year <br /> N <br /> P <br /> O 16 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Pnntedrryped Name Signature Month Day Year <br /> E <br /> R <br /> 44� 19 Discrepancy Indication Space <br /> I� <br /> F <br /> A <br /> C <br /> 20 Facility Owner or Operator Certification of receipt of waste matenais covered by this manifest exce as noted in Item <br /> t <br /> Y <br /> Printed/Typed Name nature y Year <br /> BILL ARTAMENKO <br /> I Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Ill Neenah W154957-03S8 <br /> ORIGINAL - RETURN TO GENERATOR <br />