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please pprtntortwe <br /> (Form designed for use on elft(12 pitch)typewriter J <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST n/a 0001 1 °f 1 <br /> 3 Generator's Name and Mailing Address <br /> Cheveron <br /> Y hwy 12 loch , ca <br /> 4 Generators Phone( 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 673-8201 <br /> I 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> t 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone . <br /> a <br /> znviro tec R �9 <br /> 2480 athens ave <br /> _4 lincolnr ca 95643 n/a 434-0211 <br /> r�H 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total <br /> No I Type Quantity W 0 ,l, <br /> a <br /> R <br /> non haz waste liquid nos <br /> waste water 001 tt <br /> G b k4 <br /> taw E <br /> t N <br />'w R <br /> " A c <br /> T <br /> * O <br /> R �} I <br /> d <br /> fJ <br />'IqlFD Additional Descnpthons for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> , <br /> - 15 Special Handling Instructions and Additional Information <br /> emerg; ; abco trey w. 916-826--3803 <br /> 16 GENERATOR'S CERTIFICATION I oenity the materials described above on this manifest are not subject to federal reguWions for reporting proper disposal of Hazardous Waste <br /> Ii r Printed/Typed Name Signature Month Day Year <br /> r <br /> T 17 Transpo cknowledgement of Receipt of Materials ' <br /> w A 'fe ed Name Sign Mi2av yeaL <br /> r S i <br /> P <br /> # O 16 Transporter 2 Acknowledgement of Receipt of Materials v <br /> R <br /> EPnntedlTyped Name Signature Month Day Year N <br /> R <br /> 19 Discrepancy Indication Space <br /> I F <br /> A <br /> C <br /> 24 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Y <br /> ped Name Signatu Month Day Year <br /> Pnnted by J J KELLER&ASSOCIATES INC 12-8L5-05 Rev 2l9$ <br /> Neenah WI 54957 0369 <br /> ORIGINAL- RETURN TO GENERATOR <br />