Laserfiche WebLink
plea"print rm or type <br /> (Fodesigned for use on able(12-pitch)typewriter) <br />' NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doe No 2 Page 1 <br /> WASTE MANIFEST n/a 0001 11Y 1 <br /> 3 Generator's Name and Mailing Address <br /> cheve ron <br /> hwy 12 lode , ca att; ; tim <br /> 4 Generator's Phone( 209 ) 467 1006 <br /> zT 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n/a 673-1923 <br /> ;= 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone v <br /> i Y I <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> >Lnvzro tec <br /> 2480 athens ave <br /> lzncoln, ca 95648 n/a 434-0211 <br />'r 11 Waste Shipping Name and Description 12 Containers Tota! 14 <br /> No Type Quantity WWaI ` <br /> s <br /> a non haz waste liquid nos <br />' coalt ^ <br /> waste water elf Q� <br /> ria G b <br /> rA E <br /> I ,r E <br /> A c <br /> T <br /> O <br /> R <br /> IFn ; <br /> rD' Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purgw water from tank <br /> 15 Special Handling Instructions and Additional Information <br />' emerg ; ; abco troy w. . 916-826--3803 <br /> I <br /> 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 yh <br /> Printed/Typed Name Signature Month Day Year , <br /> ly <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br />' A �R1nntedrryped N e SIg t o Moran Day Year <br /> S �t rC1t 1 i <br /> P <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> ,. R <br /> F» PnntedfTyped Name Signature Mont, Day Year <br /> R r <br /> r,7 19 Discrepancy Indication Space <br /> F <br />' A <br /> C <br /> s 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as ted In Item 19 <br /> Y <br /> �nt8 ped me Signature Mon Day Year <br />' Printed by 3 J KELLER a ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI 54957-0366 <br /> ORIGINAL- RETURN TO GENERATOR <br />