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' Please pnin or tyke <br /> (Forth des{gned far use on elite(12-pdch)typewriter 1 <br />' NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Pagel <br /> TWASTE MANIFEST n a 100G1 of <br /> 3 Generator's Name and Mailing Address <br /> Cheveron <br /> lodir ca hwy12 <br /> e' b Generator's Phone( ) <br /> a} — <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter nZa <br /> 7 Transporter 2 Company Name a US EPA ID Number B Transporters Phone4F <br />' x 9 Designated Facility Name and Site Address 14 US EPA ID Number C Factitty's Phoney"; <br /> f inviro tec � 5 <br /> 2480 athens ave n/a 434-0211incaln ', ca 95648 k3 =y <br /> e� ;xrr <br /> 13 14 <br /> 11 Waste Shipping Name and Description 12 Containers Total Unit y <br /> No Type Quantity WtNol � <br /> a � <br /> non haz waste water nos 001 tt 1300 gals ; <br />' -Rv L) <br /> G i <br /> E <br /> N , <br /> E r,i <br /> R 4- <br /> x A c a <br /> t 0 <br />' r a R <br /> °c f <br /> of ti <br /> r�� r <br />' ❑ Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> b �F <br /> purge water from tank <br /> ,a <br /> t- 15 Special Handling instructions and Additional Information <br /> emg abco <br /> troy 916-826-3803 <br /> F <br /> t <br /> 16 GENERATOR'S CERTIFICATION i certify the male nals deacnbed above on this manifest are not aublect to federal r.g"cations far reporting proper disposal of Hazardous Waste K <br /> c' PnntedlTyped Name Signature Month Day Year <br /> 2 <br /> +<' T 17 Transporter 1 Acknowledgement of Receipt of Matenals <br /> R <br /> A A ntedflyped Na Si Month Day Year <br /> N 6100 <br /> 11 <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials �s <br /> u T PnntedFTyped Name Signature Month Day Year <br /> r E <br /> R <br /> 19 Discrepancy Indication Space } <br /> N1- <br /> F <br /> 7 G <br /> pFactlity er or operator-Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Yd Name Signature <br /> Mo ay Y <br /> BTT-:-r ARTAm:ENRe <br />' Printed by J J KFILER a ASSOCIATES Mc 12-BLS-05 Rev 12/98 <br /> Neenah msass7-ossa ORIGINAL- RETURN TO GENERATOR <br />