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Please pont w type <br /> (Form designed for use qn eine(12-pdcnl typewriter) <br />' NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Pagel <br /> ALI WASTE MANIFEST n a 0001 1°f 1 <br /> 3 Generators Name and Mailing Address <br /> a cheveron , <br /> as lode., ca <br /> 4 Generator's Phone( 209 467-1006 ti <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone pw <br /> thrifty rooter L n a 673-8201 Y <br /> ti <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone <br /> Ph <br /> r L 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> � J.T1VZr0 teC '1'r <br /> 2480 athens ave <br /> xq lincoln, ca 95648 n a 1 434-0211 A <br /> 11 Waste Shipping Name and Description 12 Contamers 13 14 <br /> t Total Unit r <br /> Na I Type Quantity WVVol <br /> non haz waste liquid <br /> 001 t gal <br /> waste water , <br /> �} n <br /> se G b �> <br /> sM� E <br /> N . <br /> " E <br /> A c <br /> T <br /> 1 R <br /> ❑ Additional Descriptions far Materials Listed Above E Handling Codes for Wastes Listed Above <Y� <br /> ,Ms „r <br /> purge water from tank ' <br /> f <br /> �i dal <br /> US ' <br /> f <br /> 12 15 Special Handling Instructions and Additional Information <br /> iF+trn <br /> 1 emrg contact, troy w. 916-826-3803 <br /> 16 GENERATOR 5 CERTIFICATION t cer¢fy the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> �n Pnntedrryped Name Signature Month Day Year ; F` <br /> Pm , <br /> ,X r+ <br /> f+as <br /> T 17 Tr nowledgement of 1 of Materials <br /> x R - <br /> jr nt ed Name ignature moop Da agar <br /> P y J ti <br /> r O 18 Transporter 2 Acknowledgement of ReceqA o1 Materials <br /> s�3 <br />'y T PnntedlTyped Name <br /> Signature Month Day Year <br /> E <br /> R 4 <br /> #�s <br /> y 19 Discrepancy Indication Space r, <br /> F <br /> C <br /> 20 Facility Owner or operator Certification of receipt of waste materials covered by this manifest except as noted in Item 1.9 <br /> Y <br /> Printed/Typed Name Signature fG } "J gnth Day Year <br /> B 261 ILL ARTAMENKO Y�. f�1 /��} <br />' Printed by J J KELLER&ASSOCmTES iNC 12-BLS-05 Rev 17J98 <br /> Neenah WI 54957 0368 ORIGINAL--RETURN TO GENERATOR <br />