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i <br /> Please print or type <br /> (Form deigned for riseOn elite(12 pitch)typewrrter <br /> �NNM�HRDOUS 1 Generators U5 EPA ID Ne Manifest Doc No 2 Page 1 <br /> NIFEST n a 0001 1°f1 <br /> 3 Generator's Nae and Mailing Address <br /> cheveron <br /> s, hwy 12 lode , ca att; , tim , <br /> - 4 Generator's Phone( 209 ) 467n —1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n/a 673-1923 aE <br /> 7 Transporter 2 Company Name 8 U8 EPA ID Number 8 Transporters Phone <br /> .l <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone <br /> invi.ro tec <br /> 2480 athens ave � s <br /> r lincoln, ca 95648 n/a - 434-0211 <br /> 11 Waste Shipping Name and Description 12 Containers 13 144 <br /> Total Unit y , <br /> No I Type Quantity Wt/Vol <br /> , u <br /> a <br /> non haz waste liquid nos <br /> waste water 001 tt � <br /> G b <br /> .; <br /> N <br /> R <br /> A c v <br /> r T <br /> Q 4yr <br /> R <br /> i� <br /> _ dD Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water fom tank <br />'V <br /> i <br /> 15 Special Handling Instructions and Additional Information <br /> emerg; ; abco troy w. 916-826-3803 <br /> R GM1 <br /> 16 GENERATOR'S CERTIFICATfON I ce the materials described above on this manifest are not subject to federal regulations for reporting nrfy g propor disposal of Hazardous Waste r" <br /> Printed/Typed Name Signature Mo a Year <br /> y T 17 Transporter 1 Acknowledgement of Receipt of Materials a, <br /> A f=ed Name 51 re � Mon Ra Year ' <br /> N <br /> xw S - <br /> t P <br /> H18 Transporter 2 Acknowledgemen of Receipt of Materials v <br /> r T Printed/Typed Name Signature Mont, nay Year <br /> E <br /> 19 Discrepancy Indication Space <br /> rf <br /> 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 Item 19 <br /> Y <br /> Yped Name M fh pay Year <br /> a <br />' Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI54957036g <br /> ORIGINAL_RETURN TO GENERATOR <br />