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Please prtM er rypa i <br /> (Forth des+gr ad lfpr usa on elite(12-pitch)typewriter} <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doe No 2 Page 1 <br /> WASTE MANIFEST nif <br /> 3 Generator's Name and Mailing Address <br /> cheveron <br /> lode , ca <br /> 4 Generators Phone( 209 467 1006 t 1 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter -613-8201 <br /> 7 Transporter 2 Company Name 8 US EPA iD Number B Transporters Phone <br /> r <br /> P <br /> JI <br /> 9 Designated Facility Name and Site Address 10 US EPA IO Number C Facility s Phone <br /> r <br /> 1nVlr4 tec rrAY <br /> _ 2480 athens ave <br /> 1 =01n , ca 95648 r/A <br /> 11 Waste Shipping Name and Description12 Containers 13 14 , <br /> Total Unit <br /> i No Type Quantity WttVot " 3 <br /> a ri <br /> non haz waste liquid <br /> waste water 001 tt ; <br /> irk <br /> G b s <br /> N <br /> R <br /> =' A c <br /> T <br /> O 1F <br /> R d <br /> t <br /> D Additional Descriptions for Materials Listed Above E Handling Codas for Wastes Listed Above <br /> i <br /> purge water from tank <br /> 1' <br /> 15 Special Handling Instructions and Additional Information <br /> wear ppc <br /> emerg abco troy w. 916--826-3803 <br /> 16 GENERATOR'S CERTIFICATION I certdy the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> Printed/Typed Name Signature Month Day Year <br /> yr i a <br /> rr <br /> TR 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> A R to yDed Name Sin Month Day Year <br /> P <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> ' T Pnnted[Typed Name Signature Monro Day Year .F <br />' * R v <br /> s 19 Discrepancy Indication Space <br /> 4?� <br /> F <br /> A <br /> C <br /> !20EFacility er or Operator Certification of receipt of waste matena[s covered by this manifest except as noted rn Item 19Y d Name Si Ile Month Day Year <br /> artamenko <br />' Printed by J J KEUER g ASSOCIATES INC 12-BLS-05 Rev 12188 <br /> Neenah WI 54957-0368 ORIGINAL-RETURN TO GENERATOR <br />