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Pfeese pprim or type <br /> {Farm designed for use on elite(12 pitch)typewriter} <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST 0001 of <br /> 3 Generator's Name and Mailing Address <br /> cheveron <br /> hwy12 lode , ca <br /> 4 Generator's Phone( 209 ) 7— <br /> 5 Transporter 1 Company Name 6 US EPA 1D Number A Transporters Phone <br /> I thrifty <br /> 7 Transporter 2 Company Name a US EPA ID Number B Transporters Phone <br /> ria <br /> ' 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone h_ <br /> a <br /> f znviro tec <br /> 2480 athens ave lincoln, c 95648 n/a 434-0211 <br /> N 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit '9F <br /> No I Type Quantity Wt/Vol <br /> a non haz waste liquid nos <br /> r_ waste water 001 t <br /> tj �r r <br /> G b <br /> uy E <br /> N <br /> e E H <br /> f5i R <br /> A c <br /> T <br /> R d <br /> _ I <br /> � D Additional Df?scnptions 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 /> Iemerg ; abco troy w. 916--826-3803 <br /> rF <br /> Fly <br /> } <br /> -yi <br /> �Tv <br /> 16 GENERATOR S CERTIFICATION I certify the matenais described above on this manifest are not subject to federal mguiations for reporting proper disposal of Hazardous Waste <br /> Pnnted/Typed Name Signature Month Day Year <br /> r' R 17 Transporter 1 Acknowledgement of Receipt of Matenals L <br /> A nted/Typed Name Sint Month Day Year <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> EPnnted/Typed Name Signature Month Day Year - <br /> R <br /> 19 Discrepancy Indication Space <br /> s 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 Ite -7 <br /> r <br /> IY Printed/Typed Name S e Y Month Day Year <br /> bz11 artamenk0 - 0 <br /> Pnnted by J J KELLER&ASSOCIATES INC R{r 12-BLS-05 Rev 12/98 Neenah WI 54957-03gg <br /> -- <br /> ORIGINAL RETURN TO GENERATOR <br />