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Please prnot ar type <br /> (Form des,gmd for itse on elite(12-pitch)typewriter) <br /> f-NON;HAZARDOUS 1 Generators US EPA ID No ManifestDoc No 2 Page1 <br /> WATE MANIFEST n/a 001 13t 1 <br /> 3 Generator's Name and Mailing Address <br /> Cheveron <br /> lode , ca <br /> 4 Generator's Phone( 209 ) 467 1006 tim <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> thrift <br /> Y rooter n/a 673-8201 <br /> 7 Transporter 2 Company Name 6 US EPA ID Number B Transporter's Phone <br /> r;t - <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> inv1_ro tec <br /> i µ „{ <br /> 2480 athens ave <br /> ' lincoln , ca 95648 n/a 434-0211 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantity Wt/Vol ; <br /> a <br /> inon haz waste liquid <br /> waste water001 tt 3000 gal54 <br /> a' G b <br /> r E ' <br /> N <br /> R <br /> A c r,t <br /> ttit 0 <br /> R I <br /> d <br /> i <br /> iD Additional Descriptions for Matertais Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> li <br /> 15 Special Handling Instructions and Additional Information °r <br /> _ a <br /> wear ppc <br /> emerg/ abco troy w. 916-826-3803 <br /> ret .'4i <br /> k 16 GENERATOR'S CERTIFICATION i certify the materia#s described above on this manrtest are not subject to federal regulations for reporting proper disposal of Hazardous Waste aq <br /> PnntedrTyped Name Signature Month Day Year <br /> _ tx <br /> r � <br /> a <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R T <br /> A Printed/Typed Name Signature Month nay Year <br /> r. N <br /> S � 1 <br /> P " <br /> r A R 18 Transporter 2 Acknowledgement of Receipt of Materials 4 <br /> EPnntedrTyped Name Signature Month Day Year <br /> R <br /> ° 19 Discrepancy Indication Space ,xF <br /> Y F r <br /> C w <br /> i <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> a <br /> Y Printedrf yped Name t ` r / �� Month Day Year <br /> Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 1219$ <br /> Neenah WI 54957-WB8 <br /> ORIGINAL--RETURN TO GENERATOR <br />