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Farm designed for use on h) <br /> � AQ <br /> � 9 elite(12-pitch)typewriter <br /> NOI�j-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 M1 <br /> WASTE MANIFEST n/a 0401 1 of 1 <br /> 3 Generators Name and Mailing Address <br /> chevveron <br /> hwy 12 / lodi , ca att : TIM <br /> i 4 Generators Phone( 209 ) 467-1006 <br /> L <br /> 6 5 Transpoler 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> s <br /> INVIRO TEC n/a 434-0211 <br /> s7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> I <br /> I S Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> k znviro tec <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 cuartily MA of <br /> a <br /> non haz waste liquid nos <br /> ]waste hater from tank] Q01 t <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> R <br /> a emgs abco / trop ZIT. 916-826-3803 <br /> __y^��_G z l/ .d fI <br /> f D Adoil,o,)al De<cnpliors for Mj8lcriais Lisred Aoove E hanciang Codes lot%'Vasles Listed Above <br /> I Spccial Nara-rg InsirLctions and Adoworai ri'o'Tc or <br /> E <br /> 16 GENERATOR S CERTIFICATION I ccr 'e e s dtsc rbe4�abo%c cry 10-1 E51 e rot "eci to fcceror eci z ors r- eper'i,o p o,cr d ecal of hazrr['c ldrl e <br /> Prm eo Tt peo NP-ne Sig-a w e IIcn r Dav I r. <br /> I I <br /> T 17 Trancporer i AckncA1eoge--ten'of Reccipi of lvtare als <br /> R ` J <br /> A { Pnnted Typed Name i Signa u <br /> S �� ✓/ f i C <br /> P I <br /> O 118 Transporter 2 Acknov.ieogement of Rece-pt of V�aleria s <br /> R <br /> T I Pnnled/Typed Name i Sign;.ture morrx Da; Year <br /> E / <br /> R <br /> 19 Discreppric) Indication Space <br /> F <br /> A <br /> C <br /> 0 Facility Ot%ner or Operalor CenrAca ion of receipt o'i%as a materials Covered by this rre,iilesl except as noted in I<em 19 <br /> PrintedTvped Name j Srgnalu e mon Day taar <br /> BILL ARTAMENK0 <br /> PnnteobyJ J KELLER A ASSOCIATES rNC r <br /> Neenah WI 54957 0312-BLS-05 Rei 12198 <br /> 68 ' ' <br /> r _ TRANSPORTER #1 <br />