Laserfiche WebLink
' pleasepont or <br /> (Form designed far use on elks{12•pitch)lyparnter) <br />' u NON-HAZARDOUS 1 Generator's U5 EPA ID No Manifest Doc No 2Page 1 <br /> WASTE MANIFEST N/a 0001 1 of 1 <br /> 3 Generators Name and Mailing Address <br /> cheveron <br /> hwy 12 lode ca 209-467--1006 tim "- <br />' 4 Generators Phone <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 /> ^~ 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone ' <br /> A znvaro tec n/a 434-0211 <br /> 2480 athens ave i <br /> lincoln, ca 95648 ; <br /> �< <br /> 11 Waste Shipping Name and Description Containers 13 14°n Total Unit <br />' No Type Quantity Wt/Vol., <br /> a non haz waste liquid nos 001 tt 1800 gal -u <br /> / X <br /> G b <br /> E <br /> N <br /> � E <br /> A c <br /> T <br /> a o <br /> f R <br /> 1 d <br /> 1 D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> ,L <br /> - 15 Special Handling Instructions and Additional Information <br /> emg // abco <br /> 1 troy w 916-826-3803 <br /> 1 <br /> 16 GENERATORS CERTIFICATION I certify the materials described above on this mandest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> Printed/Typed Name Signature Month Day Year <br /> `4 <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A r ted/Typed Nam Sig t e Month Day Year <br /> 19 P �I C 1C iZ, n�� <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> EPrinted/Typed Name Signature Month flay Year J� <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Facility Owner or Operator Certification o1 receipt Of waste materials covered by this manifest exce as noted in Item 19 <br /> 1 Yea <br /> yped Name Signature <br /> Pnnted by J J KELLER&AS CIATES INC 12-BLS-05 Rev 12198 <br /> Neenah w154957 0368 ORIGINAL-RETURN TO GENERATOR <br />