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Please pnM or <br /> (Form designed r use on elite(12 pitch)typewri0er) <br />' NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST of <br /> 3 Generator's Name and Mailing Address <br /> >i <br /> cheveron " <br />' lodi , ca hwy12 <br /> 4 Generator's Phone( ) 7— <br /> j 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter n/.a 673-8201 <br /> + 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone i <br />'f 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> si <br /> f znvxro tec <br /> 2480 athens ave n/a 434-0211 <br />' F 11 Waste Shipping Name and Description 12 Containers 13 14 of <br /> Total Unit <br /> No Type Quantity Wt/Vol _ <br /> a non haz waste liquid 001 tt 3000 gaff <br /> 110, <br />'u waste wat,�rq b73 ° <br /> a <br /> N >> <br />' r R <br /> +'} A c <br /> t <br /> 0t€a <br /> R i�fsr <br /> 'w d r� <br /> D Adddional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above �11x 4'1 <br /> ti purge water from tank <br /> R$ <br /> _d <br /> 15 Special Handling Instructions and Additional Information <br /> 1!, emerg contact ABCO TROY W. 916-826-3803 <br /> ,u t <br /> X � � <br /> ix <br /> xy <br /> of 16 GENERATOR'S CERTIFICATION I certify the materials described above on this manifest are not subject to federal reguiations for reporting proper disposal of Hazardous Waste ,ice <br /> 4° 9 <br /> Pnnted/Typed Name Signature Month Day Year <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R ss <br /> AP tedR Nam <br /> yped Sig a Mon Day Year ,f <br /> 1 rip S L <br /> O 18 Transporter 2 Acknowledgement of Receipt of MatenalsIR <br /> �1 <br /> E Pnnted/Typed Name Signature Month Day year s <br /> W <br /> ve4 R �A <br /> 19 Discrepancy Indication Space <br /> e <br /> UIF r, <br /> A ' <br /> c <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Y _ <br /> Printed./Typed Name Signature Month Day Year <br /> Printed by J J KELLER$ASSOCIATES INC w 12-BLS-05 Rev 2/g$ <br /> Neenah WI 549570368 ORIGINAL-RETURN TO GENERATOR <br />