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i - <br /> Please pnm or type <br /> {Form dpsagned for use on eldp(12 pitch)typewriter) <br /> i NONHAZARDOUS 1 Genorator's US EPA ID No Manifest Doc No 2 Page 1 <br /> 7ASTE MANIFEST of <br /> n a <br /> 3 Generators Name and Mailing Address <br /> cheveron <br /> k hwy 12 lode , ca <br /> 4 Generators Phone( 209 ) 467 1006 att• ;tlm <br /> s <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n a 673-8201 <br /> i m 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone <br /> 9 Designated Facility Name and Site Address t0 US EPA ID Number C Facility's Phone <br /> sw w <br /> invlro tec rr <br /> s 2480 athens ave <br /> llncoln, ca 95648 n a 43 -0211Yrwr <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 1 <br /> � l Un.it <br /> ,, No Type Quantity Wt(Vol <br /> 4 <br /> 'y a non haz waste liquln nos <br /> k I <br /> w� waste water 0101 tt r <br /> E� <br /> ' -Ale <br /> T <br /> y <br /> 'o E V <br /> N n <br /> hA <br /> E <br /> R <br /> A c <br /> T }` <br /> ti} O € <br /> f, R o g <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> r <br /> 15 Special Handling Instructions and Additional information <br /> U" <br /> ' I <br /> emerg; ; abco troy w. 916-826-3803 <br /> MF <br /> lyt <br /> 5 <br /> i 16 GENERATOR'S CERTIFICATION I cerbfy the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste .- <br /> ti Printed/Fyped Name Signature Month Day Year <br /> r" r_ <br /> i TR 17 Trans Acknowledgement of Receipt of Materials <br /> A ped Name S u / Monro D YearIN a `; <br /> P C� <br /> R 18 rarisporter 2 Acknowledgement of Receipt of Materia#s <br /> tv T Pnnted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> r 19 Discrepancy Indication Space <br /> rw - <br /> w <br /> I F <br /> A <br /> C <br /> 1 <br /> 20 Facslity Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in 1 19 <br /> Y Pn d Name Sign Month Day Year <br /> Printed by J J KELLER g ASSOCIATES NC: 12-BLS-05 Rev 12/98 <br /> Neenah WI 54957 0368 <br /> ORIGINAL- RETURN TO GENERATOR <br />