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I <br /> Pleasetint ar type <br /> (Form 9=rwd for use on elite(12-pit h)typewriter) <br />' NON-HAZARDOUS 7 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n/a O001 1 A <br /> 3 Generator's Name and Marling Address <br /> chevron - ' <br />' lode , ca <br /> 4 Generator's Phone(2 0 9 ) 4671006 t l m r <br /> 5 Transporter 1 Company Name 6 US EPA 1D Number A Transporter's Phone <br /> 4e <br /> rCl <br /> thrifty tec n/a 673-1923 <br />' 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone a4 <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br />' lnvir0 tec Aiv� <br /> 2480 athens avew <br /> lincoln, ca 95648 n/a 434-0211 <br /> ^sf <br /> t� 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description Total Unit <br /> No Type Quantity Wt/Vol v <br /> a <br /> non haz liquid wasterY <br /> waste water I ® � (� <br /> r h � <br /> G b f, <br /> E <br /> N <br /> E <br /> R <br /> A o <br /> 1Z <br /> 0 'fit <br /> R y <br /> d purge water from poly tank <br /> 1 D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> w emg contact ; abco / troy w 916 826-3803 a <br /> 15 Special Handling Instructions and Additional Information <br /> E <br /> IM1„ J• u H ' <br /> h <br /> r'cV <br /> M� <br /> � � 4 <br /> 16 GENERATOR'S CERTIFICATION i realty the matenals described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> a ypedNatge _ month Days year <br /> r- <br /> 1 T 17 Transporter 1 A knowledgement of Receipt of Materials <br /> R <br /> ' A d/Typed NarA cfa rearr11 <br /> ' <br /> N r <br /> S — <br /> O18 Transporter 2 Acknowledgement of Receipt of Materials Y r <br /> R <br /> T Pnnted/Typed Name Signature Month Day Year <br /> h E <br /> R ^ <br /> ' 19 Discrepancy Indication Space k r <br /> F 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 /> p d Name Signature Month nay Year <br /> 9 18 12000 <br /> IPnnted by J J KELLER&ASSOCIATES INC 12-SLS-05 Rev 12198 <br /> Neenah,WI 54957-Dis8 ORIGINAL- RETURN TO GENERATOR <br />