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Please pnM or type <br /> (Farre designed for use on elite(12-pdrh)typewriter) <br /> NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST at <br /> F <br /> 3 Generators Name and Mailing Address <br /> cheveron <br /> hwy 12 lode. , ca att; ; tim <br /> I y' <br /> Q Generators Phone( 209) 467-1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone ti <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone <br /> inviro tec M <br /> 2480 athens ave <br /> ,If h, <br /> lincoln, ca 95648 n/a 434-0211 F�f <br /> F12 Containers 13 14 <br /> 11 Waste Shipping Name and Descnphon ,res <br /> Total Unit , <br /> NoType Quantity WI/Val + <br /> S <br /> a waste liquid non haz ", <br /> waste waster nos 001 tt <br />�t�k rb <br /> E b <br /> E # <br /> R <br /> A c x� <br /> w T <br /> e R t <br /> d <br />' D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> f, purge water from tank <br /> �Y <br /> 15 Special Handling Instructions and Additional Information <br /> emerg' ' abco troyw. 916-826-3803 F, <br /> e <br /> S A Sf <br /> t� 16 GENERATOR S CERTIFICATION I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste t <br /> Pnnted/Typed Name Sgnature Month Day Year ,1 <br /> 1~+ T 17 Transporter 1 Acknowledgement of Receipt of Materials r!_ <br />�v+ A ped Name <br /> r P GGA s <br /> RTransporter 2 Acknowledgement of Receipt of Materials <br /> T Printedlryped Name Signature Month nay Year <br /> E ay <br /> R \ <br /> 19 Discrepancy Indication Space <br /> ^S <br /> iS <br /> l <br />' F <br /> A <br /> G <br /> i <br /> 20 Facility Owner or Operator Certification of recerpt of waste mate nals covered by this manifest except as noted in Item 19 <br />' Y P edfr <br /> ma n c._. M ay Year <br /> Printed by J J KELLER g ASSOCIATES INC' 1Neenah W154957-a36a 2-BLS-05 Rev 12198 <br /> ORIGINAL-RETURN TO GENERATOR <br />