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=F-1.1n <br /> lease pnrt ar type <br /> (Form designed for use on eI to(12 pitch)1ypewrlter) <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 ::: k, <br /> Cheveron <br /> ' 1odx , ca tim <br /> r 4 Generator's Phone( 2 0 9 ) 467-1006 <br /> � <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> theifty rooter n/a 673-8201 ' <br />'r1 7 Transporter 2 Company Name 8 US EPA ID Number H Transporter's Phone <br /> t <br /> �y <br /> ra 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone $i <br /> F Znvlro tec <br /> 'n< r <br /> 2480 athens ave. <br /> lincoln, ca 95648 n/a 434-0211 14 <br /> 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description Total Unit ;a <br /> No Type Quantity WtNal �$4 ' <br /> non haz waste liquid <br />'k waste water 001 tt <br /> G b }j s <br /> E � <br /> Ne, <br /> R z a <br /> �Y A C y <br /> T q v <br /> �* 0 <br /> C <br /> R All <br /> d <br />'z D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above I <br /> pc � <br /> Frye purge water from tank <br /> 'Y 4iy' <br /> Ka <br /> 15 Special Handling Instructions and Additional Information J <br /> ay <br /> emerg contact ABCO TROY W. 916--826 3803 <br /> :- <br /> 16 GENERATOR S CERTIFICATION i certify the matenals desenbed above on this manifest are not subject to tederal regulations for reporting proper disposal of Hazardous Waste F� <br /> Printedfryped Name Signature Month Day year <br /> IV <br /> f, TR 17 Transporter i Acknowledgement of Receipt of Materials r <br /> S d Ns �✓ Sig re ria°" D y r <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials ; <br /> rt T PnntecVryped Name Signature Month Day Year mss' <br /> E ^�J <br /> R d- <br /> 4-'} 19 Discrepancy Indication Space A, <br /> F F <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted In Item 19 } <br /> Y J r <br /> Pnntedfryped Name Signature ��, J.Monfh Day Year <br /> B LL ARTamRNKn � <br />' Printed by J J KELLER$ASSOCIATES INC Ir '�rt r98 <br /> Neenah WI 54957-0368 ORIGINAL- RETURN TO GENERATOR 12-BLS-05 Rev 2 <br />