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Please print or type <br /> (Form designed for use an elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br />' WASTE MANIFEST n a 0001 1of <br /> 3 Generator's Name and Madmg Address <br /> i� cheveron <br /> Jodi , ca <br /> w, 4 Generator's Phone 209 ? 467-1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone a <br /> thrifty rooter n/a 673-82QI <br /> 7 Transporter 2 Company Name a US EPA ID Number t3 Transportet's Phone <br /> r a <br /> n 9 Designated Facility Name and Sao Address 10 US EPA ID Number C Facility s Phone 1� <br /> invlro tec <br /> TM 2480 athens ave <br /> lincoln, ca 95648 n a 434-0211 A <br />' 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description Total Unit a <br /> r , No Type Quantity WVV01 <br /> �rn a non haz liquid waste <br /> waste water 001 tt <br /> E b 4000 gal _ ° <br /> � N <br /> % <br /> I_ i <br /> •� °Fxrl <br /> r A c s� <br /> T '9 <br /> K4 R <br /> d <br /> 1 5° <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above rim <br /> purge water from tank s; <br /> 15 Special Handling Instructions and Additional Information <br /> a i <br /> emerg contacyr abco troy w. 916-826-3803 <br /> r� ks <br /> r� <br /> 4�zt <br /> 1Y� sr`t� <br /> 16 GENERATOR'S CERTIFICATION 4 certify the materials dascnbed above on this manrfest are nat subject to federal reguiadons for reporting proper disposal of Hazardous Waste <br /> Printedfryped Name Signature Month Day year <br /> A` TR 17 Transporter 1 Acknowledgement of Receipt of Materialsh4 <br /> ar A Print ped Ne Signa r c Month Day rear x,r= <br /> SIs r � ted //r # r <br /> P <br /> r O 18 Tr nsporter 2 Acknowledgement of Receipt of Materials ;i) <br /> 1 E Printed/Typed Name Sgnature Month Day rear <br /> 1y� R <br /> 1 <br /> } 19 Discrepancy Indication Spacer <br /> y� <br /> t 3� rt <br /> F w <br /> C t, <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifesi except as npted in Item 19~r <br /> Y Printedayped Name Signa raa �r. y Month Day year <br /> V <br /> F ✓a <br /> BILL ARTAMENKO - " ' `=' - <br /> Printed by J J KEt1ER 8 ASSOCIATES INC <br /> Neenah w1549570368 ORIGINAL-RETURN TO GENERATOR 12-BLS-05 Rev 12198 <br />