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Please print or type <br /> (Form designed for use on elft 412p&eh)4pewnter,jT_ r <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST n/a 0001 lel 1 <br /> 7r3 Generator's Name and Mailing Address <br /> cheveron <br />' p lod a r ca hwy 12 <br /> 4 Generators Phone( 209 467-1006 tam <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> ~ <br /> thrifty rgot673 820i <br /> 7 Transporter 2 Company Name S US EPA ID Number B Transporters Phone j <br /> 'rx <br /> 9 Designated Facility Name and Site Address 1U US EPA ID Number C Factlitys Phone <br /> invi.ro tec <br /> 24.80 athens ave n/a 434-0211 <br /> lancoln ca 9564812 Containers 13 14 ` <br /> €a 11 Waste Shipping Name and Descnption Total Unit " <br /> No Type Quantity WWaI s <br /> a non haz liquid waste f �� <br />' waste water 001 t <br /> ij G b <br /> E <br /> N <br /> R <br /> A c <br /> Yi T <br />' O <br /> d <br /> i, <br />' D Addtttonal Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> f <br /> 15 Special Handling Instructions and Additional Information <br /> emerg contact ; , ABCO TROY W. 916-82603803 <br /> 1 i <br /> 16 GENERATOR S CERTIFICATION I certity the materials described above on-his manifest are not subject to federal regulations for reporting proper disposai of Hazardous waste <br />' E <br /> Printed/Typed Name Signature Month Day Year t <br /> T ran orter 1 Acknowledge"",,,l Receipt of Matenals <br /> APnrtt yped Name ---y ignatur g Year <br /> P 1.0 <br /> O 18 Transporter 2 Acknowledgement of Rece t of Matenals <br /> TPnntedfryped Name Signature Morten Day Year <br /> E <br /> R <br /> 19 Discrepancy indication Space <br /> F <br /> A <br /> C <br /> 2LFacility Owner or Operator Certification of receipt of waste materials covered by this manifest exg6pt as noted inItem 19Y Typed Name Signa{tt}re TM Mwrrg''j Y ar <br /> Printed by J J KELLER&ASSOCIATES INC �tly- - 12-BLS-05 Rev 12198 <br /> Neenah WI 54957-0366 <br /> ORIGINAL- RETURN TO GENERATOR <br />