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PI�pnnl or type "" 2� a _ rw r <br /> �t`orm des gnarl For use on etrte(12'pWCh)lypewmer) - Y <br /> NON-HAZARDOUS 1 Generators US EPA ID No manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n/a 100001 1 of 1 1 <br /> 3 Generators Name and Mailing Address <br /> CHEVERON LODI PHN TIM <br /> r' HWY �2 lodY <br /> 4 Generator Phone( j <br /> 5 Transporter 1 Company Name 6 U5 EPA ID Number A Transposer s Phone <br /> INVIRO TEC n/a 43470211 <br /> I 7 Transponer 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> I <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> INVIRO TEC <br /> 2480 athens ave. <br /> lincoln , ca (8648 n/a 434-02111 <br /> 11 Waste Shipping Name and Description 12 Containers 14 <br /> Total Unit <br /> No Type 4uannty MVol <br /> a non naz ~waste liquid nos � � <br /> vasty water 001 tt �J c <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> R <br /> Id <br /> D Aonilional pescrp,ions for Ila e ,a1S Listed Ah.cne E handling Codes io Yras es Listed Ab,)+e <br /> ]a ] purge `-ater <br /> I <br /> 15 Special"a-idlirg Ins ructio^s dnd.Add Morar nfc ma c- <br /> I " <br /> 1 <br /> emergency 07 abco troy 916--826-3803 <br /> I <br /> 16 GENERATOR S CERTIFICATION i cc-i`y re TGE CC,C AFC aDC e a-t est ire re -_t'CL to'cac a'rega-io-s or eper rc r coer c tic<di or oa_a ca_s, erste <br /> Ptveo 7�ped Name Sig^a'.i e rdorr Lam✓ }otr <br /> � I <br /> TR 17 Trarsporer 1 AcM1ne+ Iecpeme-t of REce pi of I,a,e a s <br /> A Pf r+ e0q-;�Ed,�ar`12 �� C na,4 e `E.3l <br /> i <br /> 18 TransponEr 2 ACkno+JIedoernerl of Receipt of h"a'E a s <br /> T PnntediTyped Name I Sionature _ r4orrrh Gey "Ear <br /> E <br /> R i <br /> 19 Discreparey Indjcation Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Facile y O++net or Operator Cen,lication of receipt of++as e materials cc e ed by this^6andest except as noted in Item 19 <br /> Y �arnleoTyPed Name f �- Signaty�-\ !no h Gav 5esr <br /> Pnnied by 3 J KEt.LER 8 ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI F>4957-0368 TRANSPORTER 41 - <br />