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?lease prim or <br /> {Form designedfor use an eft(12 pitch)typewriter) <br /> NON-HAZARDOUS Generators US EPA ID No Manifest Dac No 2 Page 1 <br /> 1 <br /> WASTE MANIFEST a/a 0001 1 of 1 <br /> ( 3 Generator's Name and Mailing Address <br /> cheveron <br /> ' lodi , ca <br /> 4 Generator's Phone( 209 )467 1006 tim <br /> .j <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter n/a 673-8201 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> taw z <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> inviro tec -; <br /> r 2480 athens ave n/a 434-0211 <br /> 1 lincoln, ca 95648 wx <br /> F' 14 <br /> 11 Waste Shipping Name and Description 12 Containers Total Unit <br /> ,h <br /> 5 No I Type Quantity WtfVol <br /> a , <br /> non haz liquid waste <br /> iTaste water 001 Itt <br /> �r <br /> ry G b ; <br /> fM R <br /> A c <br /> T <br />' tl O <br /> A <br /> d <br /> tit <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> r,` purge water from tank ` <br /> L , <br /> IS Special Handling Instructions and Additional Information <br /> wear ppc when handeling <br /> emerg abco / troy w 91.6-826-3803 <br /> 16 GENERATOR'S CERTIFICATION I certify the materials described above an this manifest are not subject to federal regulations for reporting proper disposal at Hazardous Waste M <br /> y. <br /> Printed/Typed Name Signature Month Day Year ~� <br /> ix <br /> TR 17 Transporter 1 Acknowledgement of Receipt of Materials „ <br /> A Printed/Typed Name Signature Month Day Year <br /> a_ N t <br /> e` P <br /> R 16 Transporter 2 Acknowledgement of Receipt of Materials w <br /> r T Ragl4tsped Name }� Snature y Mon Day ear <br /> E <br /> 19 Discrepancy Indication Space <br /> 4 <br />�a C <br /> 20 Facility Owner or Operator Cenificatl n of receipt of waste materials covered by this manifest except as noted In Item 19 <br /> T <br /> w Y lName r Si [ �,Alp Da Year <br /> Printed by J J KELLER&ASSO IATES INC 1`Z-BLS-IirJ Rev �98 <br /> Neenah WI 54957-0368 <br /> ORIGINAL- RETURN TO GENERATOR _ <br />