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PIprint or type <br /> (Farm design dYor use on etao(12•prtch)typewmer) <br /> NON-HAZARDOUS 1 Generators US EPA iD No Mandest Doc No 2 Pagel <br /> WASTE MANIFEST f <br /> ' 3 Generator's Name and Making Address <br /> cheveron <br /> lode., ca <br /> ` 4 Generator's Phone <br /> tX209 467-1006 timr <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter's Phone <br /> kw 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> -x <br /> inviro tec x= <br /> 2480 athens ave . ' <br /> lincoln , 414-0211 <br /> 12 Containers 13 14 <br /> 11 Waste Shopping Name and Description Total Unit * , <br /> No I Type Quantity WVVot <br /> a non haz waste lj crzd `7 <br /> waste water 001 t z� J e),z:'ycqyw <br /> a G b <br /> r' E i=7 <br /> N ? <br /> E s <br /> a A c u� <br /> ` T <br /> R d <br /> D Additional Descriptions for Matenafs Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> I 4 <br /> 15 Special Handling instructions and Additional information <br /> wear ppc <br /> emerg . abco troy w. 916-826-3803 <br /> _} A <br /> 16 GENERATOR'S CERTIFICATION I certify The materials described above an this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste ,4K <br /> Printed/Typed Name Signature Month Day Year phi <br /> �j J~ <br /> 1 �# <br /> R 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> 4 <br /> Ay <br /> ped Name S at Month Day <br />�'- P <br /> r2 <br /> rk R 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> T Pnnted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> c , <br /> F <br /> A <br /> C <br /> 0 Facility Owner or Operator-Certification of receipt of waste materials covered by this manifest except as noted i <br /> Y Printed/Typed Namer Sig J Month Day <br /> Year <br /> bill artamenho 11 1000 <br /> Pnnted by J J KEI I ER A ASSOCIATES ING <br /> Neenah WI5M1B570368 12-BLS-05 Rev 12198 <br /> ORIGINAL- RETURN TO GENERATOR <br />