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Please grant er type <br /> (Form designed for use an elite(12-pitch)typewriter) <br />' NON-HA7_ARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST n/a 0001 1 °f 1 <br /> 3 Generators Name and Mailing Address <br /> I cheveron <br /> hwy12 lode , ca <br /> .' 4 Generators 209) 467-1006 att; tim <br /> # 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n/,a 673-8210 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone <br /> s <br /> k <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> inviro tec Y' <br /> 2480 athens ave <br /> r lincolon, ca 95648 n/a 434-0211 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> V Total Unit <br /> No Type Quantity WI/Vol <br /> z� asAs <br /> non haz waste liquid nos <br /> waste water 001 tt <br /> G b non haz waste liquid nos <br /> E waste water Dr,".1 '50 <br /> wA R <br /> A c <br /> xh T <br /> - O <br /> rr R <br /> d at <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> = purge water from tanks <br /> 15 Special Handling Instructions and Additional Information <br /> Y emerg; abco troy w. 916-826--3803 <br /> lv <br /> rt ' <br /> i k r2 <br /> 16 GENERATORS CERTIFICATION I cer ity the materials described above on this manifest are not subject to federal regulations dor reporting proper disposal of Hazardous Waste <br /> Pnnted/ryped Name Signature Month Day Year - <br /> TR 17 Transporter 1 Acknowledgement of Receipt of Matenals <br /> n' A P yped Name Sign e _ <br /> N -7 Month Day Year <br /> S <br /> r <br /> r� P <br /> ,n R 18 Transporter 2 Acknowledgement of Receipt of Matenals <br /> E Pnnted/Typed Name Signature Month Day Year _ <br /> 19 Discrepancy Indication Space <br /> t 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 Pnnted/Typed Name Signature- I nth Day Year <br /> bill artamenko �" - � � 10 113 20 0 <br /> Printed by J J KELLER&ASSOCIATES INC <br /> I Neenah Wt 54957-aas8 12-BLS-05 Rev 12198 <br /> ORIGINAL- RETURN TO GENERATOR <br />