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n l <br /> ti(Fonriff- •OO+eAte 12orM. I <br /> NON-HAZARDOUS ��orsUSEPAIDNo Manifest Doc No 2 Page 7 <br /> WASTE MANIFESTn/a 00001 1 of 1 <br /> 3 Generators Name and Mailing Address <br /> CHEVERON LODI <br /> HWY12 LODI <br /> 4 Generators Phone( 909 ) 467-1006 phn 't im <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> INVIRO TEC N/A 6 )(;- 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--0213 <br /> 2480 ATHENS AVE LINCOLN , CA 95648 <br /> 'k <br /> 11 Waste Shipping Name and Description Containers 13 14en Tota! Unit <br /> No I Type Quantity WWol <br /> a NON HAZ WASTE LIQUID NOS <br /> WASTE WATER <br /> f 1 <br /> G b <br /> N <br /> c <br /> R ' <br /> A c >'w <br /> T <br /> y <br /> O F <br /> R <br /> d <br /> t S, <br /> r <br /> " D Aodit anal aescnPlions for€t9a ena's L,slee AbcL e E Handling Godes`Or YJastes LIS'ed F bO e - <br /> PURGE WATER <br /> _ k <br /> It <br /> L~ <br /> r � <br /> 15 Saeciar handling insirucdons and Aooiliora4 InfO'ma on _ <br /> t _ <br /> EMERGENCY // TROY 916-826-3803 <br /> I T <br /> 4 <br /> 16 GENERATOR S CERTIFICATION I cerr y item.e r_s c-scribee-bore o- r=ma)fest a e nci!._r ect o fEceicl regulations for rcponinc proper c_pocaE o`Haza do.s% as e ti <br /> PrmledrTtiped Nene SI a u 11crR Oa✓ year <br /> Tl7 TranspO"r 1 Ackno,,Eeoge,-cnl of Rece p'of miia e cIs <br /> R — <br /> APnnled T�pedr e Signa <br /> 1 � <br /> O 18 Trancpork <br /> er 2 Acrcv ledgement of Receip'-, later a's —� <br /> R _ <br /> T P in,ed/Tvped Niame j Slgnature `anr4 Gay Y,-,r <br /> E <br /> R <br /> i 19 Discrepancy Indicalion Space <br /> F <br /> A <br /> C <br /> I <br /> L 20 Facility ONner or Operato CeTti'rca,ion e1 receipt of„aSre rnaterials covered by his man fest except as noted m Item 19 <br /> i <br /> Prinlew Name . /' mor n pad 1 ear <br /> PnnloO by J J HELLER 8 ASSOCIATES INC <br /> Neenah M 54957.0368 12-BLS-05 ev 12198 <br /> ORIGINAL - RETURN TO GENERATOR <br />