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i <br /> y i <br /> Please ppnm or type <br /> (Fame deggned for use on able(12-pdch)typewitter) <br />' NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> ITWASTE MANIFEST n/a 0001 lof 1 <br /> 3 Generator's Name and Mailing Address <br /> X1RYJtJt2Xkft9X Cheve r on <br /> hwy12 lode , ca <br />' 4 Generators Phone( 209 ) 467-1006 t im <br /> 115 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone - <br /> thrifty rooter ia/a 673--1923 <br />' 7 Transporter 2 Company Name 6 US EPA ID Number 8 Transporters Phone <br /> r„ <br /> � 55 <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone l <br /> inviro tec i <br /> ww 2480 athens ave <br /> li.ncoln, ca 95648 n a 434-021113 14 " <br />' 'v 11 Waste Shipping Name and Description12 Containers Total Unit <br /> No <br /> Type uantity WtNoi _ <br /> non hoz waste liquid nos <br /> waste water <br /> GC b e <br /> ! ' E <br /> � N <br /> ^3 R <br /> A c <br /> _ T <br /> O <br />' R <br /> r d <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 /> l { emg // abco <br /> troy w / 916-826-3803 r' <br /> 16 GENERATOR S CERTIFICATION i certify the matenals described above on this manifest are not subject to federal regulations for reporbng proper disposal of Hazardous Waste <br />' H Printed/Typed Name Signature Month Day Year <br /> 17 sporter 1 Ackr9WMiikgement of Receipt of Matenals <br /> P ted/Typed Na a Signature y a <br /> 4 7- <br /> P <br /> O 18 Transporter 2 Acknowledgeme t of Receipt of Matena#s <br /> R <br />' E Pnnted/Typed Name Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> 1 <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br />' Y PnntedrrypedName $I Day _Year <br /> BILL ARTAMENKQ <br />' Printed by J J KELLER 8 ASSOCIATES INC <br /> Neenah WI 54957-0369 12-BLS-05 Rev 12/98 <br /> ORIGINAL- RETURN TO GENERATOR <br />