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l - <br /> Please pdntor type <br /> {Farm designed for use on elite(12-pitch)typewnter) <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest Doe No 2 Page 1 <br /> WASTE MANIFEST n/a 4001 1 of 1 <br /> 3 Generator's Name and Mailing Address <br /> cheveron <br /> lode , ca <br /> rf <br /> 4 Generator's Phone( 209) 467--1006 ' <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrifty rooter n/a 673-8201 <br /> 7 Transporter 2 Company Name S US EPA ID Number B Transporter's Phone <br /> s' <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone } <br /> > inviro tec 91 <br /> 2480 athens ave <br /> lincoln, ca 95648 n/a 434-0211 <br /> 13 14 <br />'S i 11 Waste Shipping Name and Description 12 Containers Total Unit <br /> No I Type Quantity Wt/Vol <br /> a <br /> nonhaz waste liquid r: <br /> ;= <br /> 001 tt waste water , <br /> r G b w" <br /> E <br /> $ N <br /> R ' <br /> tik A c - <br /> T <br /> s0 , <br /> R <br /> Y <br /> f <br /> J <br />' t D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water fom tank <br /> f 15 Special Handling Instructions and Additional Information <br />' wear ppc ' <br /> emerg/ abco troy w. 916-826-3803 <br /> zF <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 <br /> Printed/Typed Name Signature Month Day Year <br /> IF .a <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> ay R <br /> A P nted ype me Si to Month Day Year r <br /> 5 r l £^Y <br /> P <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> T d/Typed Name Signature Manor Day Year <br /> E <br /> zF R <br /> 19 Discrepancy Indication Space <br /> F <br /> C <br /> Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> 720 <br /> Printed/Typed Name Sign a Month Day Year <br /> bill artamenko11 16 0 <br />' <br /> Printed byJ J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI 54957 0368 <br /> ORIGINAL - RETURN TO GENERATOR <br />