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L- <br /> Pleatte pprint or type <br /> (Form designed for use on elite(12-pitch)typewriter) <br /> NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> ,,LWASTE MANIFEST n/a 0001 1 of 1 <br /> 3 Generator's Name and Mailing Address s <br /> cheveron <br /> I w lodz , ca <br /> 4 Generators Phone( 200 467-1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter n/a 671-8201 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> 4 <br /> :n 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone c` <br /> invYro tec ; q <br /> 2480 athens ave . <br /> �- lincoln ca 95648 n 414-1711111 <br /> x 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description Total Unit <br /> No I Type Quantity Wt/Vol. <br /> a 3t e <br /> nonhaz waste liquid ; <br /> waste water 001 tt ��G t7 CS X-' 3 . <br /> } G b <br /> ' C N <br /> E <br /> R <br /> T c <br /> � R <br /> 7.d..'nall <br /> Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge crater form tank <br /> w ~ <br /> 15 Special Handling Instructions and Additional Information <br /> z gear ppc <br /> emer <br /> g/ abco troy w. 916-826-3803 <br /> �nn < <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 9 <br /> Pnnted/Typed Name Signature Month Day Year L' <br /> i" T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A n drryped N e Sign re Month Day Year <br /> P �t f Lk {L�.tl f <br /> x O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Pnntedrryped Name Signature Mona? Day Year <br />�r R <br /> 19 Discrepancy Indtcabon Space <br /> r <br /> F <br /> A <br /> C <br /> h <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 <br /> bil l <br /> I Printed by J J KELLER a ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI 54957-UMB <br /> ORIGINAL-RETURN TO GENERATOR <br />