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9 <br /> e° rrtor w <br /> eft eltlg�32-pitch) � . <br /> NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST n/a 00001 lot 1 <br /> 3 Generators Name and Mai#ing Address <br /> CHEVERON LODI <br /> HWY12 <br /> a Generators Phone( 209 ) 467-1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter s Phone <br /> INVIRO TEC n/a 434-0211 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> INVIRO TEC n/a 434-0211 <br /> 2480 ATHENS AVE <br /> LINCOLN, CA <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> r Total Unit At <br /> No IIType Ouantity Wt/vol N <br /> a �T <br /> NON HAZ WASTE WATER NOS <br /> WASTE WATER <br /> 001 tt � g <br /> G b K <br /> N r <br /> s R <br /> Y O c <br /> R sr <br /> Yy <br />, <br /> D Adait,onsl DescriDlions for Materials L sled Abox e E Handling Codes for Was,es L s,ed Above <br /> C ff <br /> K <br /> F purge water <br /> r <br />� I , <br /> 15 Special'iardling Instructors and AooujOnal nformelizrn <br /> t ti <br /> s <br /> t <br /> t <br /> �w <br /> emergency TROY 916-826-3803 <br /> 15 GENERATOR S CERTIFICATION I-e y the n-.e 11 S Ce>Cribed dnu.e o- ma-r'esl- e ro'cjb,Ec to lede,al egu'Qi,ors lar repon ng A per d Eposei ci Ha?ardo,.s Was e <br /> FnnliI pod Name Sicr 1 r ✓rh Dav Yrsr <br /> T 17 Tra,sporler , Ackn tilecgerne-t of Pece;pt a`Vc e a s <br /> R , <br /> A Printeo TI ped IN e �1 ` � Sign „ e ,or h cw t e r <br /> O 18 Trarspener 2 Ackne agement of Receipt o1 Ma er a's � <br /> R <br /> T Pnr,ieo/Tvped Name S gnat�re firrih pay Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20 Facehly O,+ner or Operalor Cerld,calion o1 receipt of k as,e materials cove ed 5y,his mandest except as nored <br /> I <br /> Pin yped Name ✓ &gnalure Month DD wear r <br /> Pnnled by J J KELLER 8 ASSOCIATES INC 2-BLS-05 Rev 12198 <br /> Neenah WI 54957 0368 <br /> ORIGINAL - RETURN TO GENERATOR <br />