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r J <br /> Please rrnt or type <br /> (Farm designed far tree on side(12-pitch)typ snmler) <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br />' WASTE MANIFEST Of <br /> 3 Generator's Name and Mailing Address <br /> Cheveron <br /> lode , ca <br /> ,y 4 Generator's Phone 209 ) 467-1006 ti-m <br /> ,� 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n a 673-8201 <br /> 7 Transporter Company Name B US EPA ID Number B Transporters Phone <br /> - <br /> 9 Designated Facility Name and Site Address 16 US EPA ID Number C Facility's Phone <br /> inviro tec <br /> 2480 athens ave <br /> z� lincoln, ca 95648 n a 434-0211 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> l Unit <br /> No Type Ouatity WVVol <br /> ^, a non haz waste liquid <br /> waste water 001 ta a .` <br /> G b <br /> Yz` E <br /> r " <br /> E <br /> A c <br /> T <br /> 4 <br /> ri R <br /> d <br /> rD Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water Brom tank <br /> r <br /> 15 Special Handling Instructions and Additional Information <br /> emerg contacy;TROY W. 916-826-3803 <br /> r . <br /> r <br /> 16 GENERATOR 5 CERTIFICATION I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> r <br /> Printed/Typed Name Signature Month Day Year <br /> In <br /> T47,%Tlansporter 1 Acknowledqoawnt of Receipt of Materials <br /> It r A Pn ed/TypedName } nature M y Year <br /> P <br /> R1 a Transporter 2 Acknowtedgement of ecetpt of Materials <br /> EPrinted/Typed Name Signature Month Bay year <br /> rR <br /> 19 Discrepancy Indication Space <br /> rP <br /> A <br /> C <br /> I <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> r Y B <br /> Print yped Name Sigar <br /> net d [�' <br /> r Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12198 <br /> Neenah WI 54957-0368 ORIGINAL-- RETURN TO GENERATOR <br />