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I <br /> Please pont or <br /> (Faun des�gnedfor use on elfte(12-pftch)typowrtter) <br />' NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST n/a 0001 1 of 1 <br /> 3 Generator's Name and Mailing Address <br /> cheveron <br /> l o d i , <br /> 4 Generator's Phone( 209 ) 467-1006 tim � <br /> ` 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter n/a 673-8201 <br /> 14y 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 /> K <br /> invlro tec <br /> 2480 athens ave SFT; <br />' _11911 1 <br /> 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description Total Unit ✓ �' <br /> No Type Quantity WI/Vol 7' <br /> :Yh <br /> a non haz waste liquid <br /> waste watar 001 t � ga r:4 <br /> x G b t <br /> NF <br /> r+K E <br /> R � l <br /> A c <br /> T <br /> 9 6 O <br /> a <br /> d <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes listed Above <br /> purge water from tank , <br /> m 15 Special Handling Instructions and Additional Information <br /> emerg conyact TROY W. 916--826-3803 r; <br /> 1 ) <br />' z� 16 GENERATOR'S CERI'ff=Kce <br /> ATION I rtify the materials described above an this mandest are not sablect to federal regulations far reporting proper disposal 01 Hazardous Waste r, <br /> ry Pnnted/Typed Name Signature Month Day Year <br /> a n <br /> v, <br /> T 17 Transporter 1 Acknowledgement of Receipt of Matenals �t <br /> ANili nntetf/T ed e jj Srg Month r Day Year a <br /> P ►L '\ f� L.l ,.moi r a;% <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> x, E Printed/Typed Name Signature Month Day Year r? <br /> 1 * a <br /> fi <br /> st 19 Discrepancy Indication Space <br /> F - <br />'` C <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manrfest apt as noted in Item 19 <br />' Y Printed/Typed Name Signature <br /> � Month Day Year <br /> BILL ARTAMENKe <br />' PrintedbyJ J KELLERAAsSOCiATEs INC ` 12-BLS-C6 Rev 12198 <br /> Neenah WI 54957-MS ORIGINAL- RETURN TO GENERATOR <br />