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Pleaserant or tYPe z zea"F Y ."• , r- _+r^ s �,< - <br /> f (Foran designed ffor use on elrra{12 pitch)typswrller) 3,s <br /> N )N-HAZARDOUS 1 Generators US EPA ID No Manilesl Qac No 2 Page 1 <br /> WASTE MANIFEST n/a 0001 1 of 1 <br /> 3 Generators Name and Mailing Address rs <br /> cheveron <br /> hwy12 / lodi . att tim <br /> 4 Generators Phone( 209-467-1006 <br /> r 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter <br /> i 7 Transporter 2 Company Name S US EPA ID Number B Transporters Phone <br /> 9 DesFgnaled FacrlPy Name and Stte Address 10 U5 EPA ID Number C Facility s Phone <br /> lnvlro tec <br /> 2480 athens acre I n/a 434-0211 <br /> 1nCnl-n , rn 9564R E <br /> 11 Waste Shipping Name and Descn12 Containers 13 14pt on Total Unit <br /> No Type Quantity 1wi/vol <br /> a <br /> non haz Waste liquids nos <br /> i7aste water 001 tt 6(�)U ---J <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> R <br /> d <br /> Q Additional Desc ptions for r,la v,ieds L sled Abeve E Handung Codes for Wates Lisle Abc�e <br /> purge Crater from tangy <br /> f ' <br /> i5 Speoal Fang rng InsIruciws and Additional Ir'o'n-a c'1 <br /> eng // abco <br /> troy v- 916-826-3803 <br /> I <br /> i <br /> 1$ GENERATORS CERTIFICATION CCr1%rhe^i,e F c CESCr ted aDe%e[- ^i< < c nol b eCf w rc dE GI e_�i,t ons for epcning prepe c a1�t i o'F rZc dc_s lJaa e <br /> PTin,eaiTyped Name Icy gna e r r h Day 1 ear <br /> T 17 Trarspor,er 1 AcKnov leaoe--e-t of Receipt of for e _Is <br /> A P-in ed Typcd Name _ r 1 c-M D� veer <br /> I S cnal� 6/I r y <br /> O 18 Transposer 2 AcknoMeogerrenl of Rece pl of Ma a ials <br /> R <br /> E P ved/Tvped Name Sigratu e _ Mo-in Da,, yea, <br /> R <br /> 19 Discrepancy Ind ca ion Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Facriny Owner or Operates :er't'cation of receip'o'v asle materials covered by this mani'est except as noted.n Lem 19 <br /> Pnnledrfyped Name 5 gnalU'e J j / J Mown Day t ear <br /> Printed by J J KELLER 8 ASSOCIATES ING 12-BLS-05 Rev 12198 <br /> Neenah WI 54957 0368 <br /> TRANSPORTER 41 <br />