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r' <br /> Please pnntortYo6 <br /> (Farm designed ruse on elite(12-pitch)typewriter} <br />' NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n/a 0001 1of 1 <br /> 7Pf3 Generator's Name and Mailing Address <br />' cheV'eron <br /> lode. , ca �- <br /> 4 Generators Phone( 209 ) 467-1006 l <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter n/a 673-8201 <br /> nt 7 Transporter 2 Company Name 8 US EPA ID Number 8 Transporters Phone <br />' 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> a' 1nviro tec <br /> 2480 athens ave <br /> j lincoln, ca 95648 n/a. 434-0211 <br />' 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantity WVVol <br /> a <br /> non haz waste liquid <br /> A waste water 001 tt crall. <br /> Y <br /> t G b <br /> -', <br /> I R <br /> �+ A c <br /> T <br /> O t <br /> R � <br /> d r <br />' ❑ Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> 15 Special Handling Instructions and Additional Information <br />' emerg contact; ARCO TROY W. 916-826--3803 <br /> 16 GENERATOR S CERTIFICATION I certify the materials described above on this manifest are not sublet[to federal regulations for reporting proper disposal of Hazardous Waste <br />' f <br /> Printed/Typed Name Signature Month Day Year <br /> z <br /> v T 17 Transporter 1 Acknowl ent of Receipt of Materials <br /> into gyped Name �-" *ture M D Year <br /> Pt <br /> d 18 Transporter 2 Acknowledgerneilit of Receipt of Materials <br /> R <br />' E Pnnted/Typed Name Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br />' F <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 y �T f <br /> Pnntec Typed Name Signature Montt) Day Year <br /> 231 2kl <br /> t Pnnted by J J KELLER g ASSOCIATES INC - b <br /> Neenah WI 54957-0368 � 12-BLS-05 Rev 1219$ <br /> ORIGINAL-RETURN TO GENERATOR <br />