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Please print('tune <br /> (Farm desigr:d ar use on elite(12-pltch)typewriter) <br /> NON-HAZARDOUS 1 Generators US EPA ID No Manifest Dae No 2 Pagel <br /> WASTE MANIFEST of <br /> 3 Generators Name and Mailing Address <br /> Cheveron <br /> Lodi , ca <br /> a Generators Phone( 209 )467 1006 tlm� <br /> F <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 t <br /> V N� <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone <br /> anviro tec <br /> 2480 athens ave n/a _ 434-0211 <br /> lincoln, Ca 95648 , <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> it No Type Quantity WWoi <br /> a <br /> nonhaz waste liquid S�� <br /> °*` Y <br /> G bu <br /> E <br /> d, N <br /> ~y A <br /> T C I <br /> + <br /> O -f <br /> � R d � <br /> D Additional Descriptions for Matenals Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br />� r 5 <br /> 15 Special Handling Instructions and Additional Information <br /> wear ppc <br /> F <br /> emerg/ abco troy w. 916-826-3803 <br /> ck� <br /> M sl <br /> f ti� l <br /> [tc *f <br /> a <br /> 16 GENERATORS CERTIFICATION 1 certify the matenals described above on this manifest are not subject to federal regulations for reporting proper disposai of Hazardous Waste <br /> Printed/Typed Name Signature Month Day Year M1r <br /> 1� l <br /> y TR 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> A nt d Name` — Sin r Month Day Year <br /> P <br /> 4 O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> Wz R rY <br /> YF E Printed/Typed Name Signature Month Day Year <br /> M, R , <br /> 19 Discrepancy Indication Space <br /> F <br /> A vi <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Y PnntedfTyped Name SI Day Year <br /> bill artamenko fl8go <br />' Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 1219$ <br /> Neenah WI 54957 0368 <br /> ORIGINAL-RETURN TO GENERATOR <br />