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Please print or typo <br /> (Farm designed far use on elite(12-pitch)typewnier) <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST n/a 0001 1 of 1 <br /> 3 Generator's Name and Mailing Address <br /> I cheveron <br /> hwy 12 lode , ca <br /> 4 Generator'sPhone(209 )467-1006 f <br /> .7� 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br />' i, thrifty rooter n/a 673-1923 <br /> ,z7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone <br /> 9 Designated Facility Name and Site Address 14 US EPA ID Number C Facility s Phone <br /> xnviro tec <br /> n 2480 athens ave. <br /> lzncoln, ca 94548 n/a 434-0211 <br />� <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 Total Unit <br /> No Type Quantity WI/Vol <br /> non haz waste liquid nos .�j �� <br /> G b <br /> E r{{ <br /> ' E <br /> to R <br /> r A c <br /> r T t , <br /> F <br /> O � <br /> R - <br /> � <br /> d <br />�i D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge waqter fore tank ' <br /> r <br /> 15 Special Handling Instructions and Additional Information <br /> emerg ; ; abco troy w. . 916-826-3803 <br /> a <br /> V <br /> 16 GENERATOR S CERTIFICATION I certify the matennis described above on this manifest are not subject to federal regulations for reporting proper disposai of Hazardous Waste .Y a <br /> PrintedlTyped Name Signature Month Day Year y <br /> Y' <br /> r� <br /> ,x TR 17 Transporter 1 Acknowledgement of Receipt of Materials y <br /> NPrrr4yeed am SI a Month Day Year tiL� <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials ,E <br /> T PnntedlTyped Name Signature Month Day Year <br />'% R <br /> R t 19 Discrepancy Indication Space <br />'= C <br /> 1 <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br />' Y PnntedrTyped Name Signature Month ay Year <br /> b <br />' Printed by J J KELLER$ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI 54957-0368 <br /> ORIGINAL_RETURN TO GENERATOR <br />