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I Please Print or type <br /> (Fomt designed for use on elite(72-pitehj fypewrtter) t <br /> NON-HAZARDOUS 1 Generators US EPA ID No MantieSt Doc No 2 Page 1 <br /> WASTE MANIFEST n/a ODO1 1 of 1 <br /> k 3 Generators Name and Matlrng Address <br /> cheveron <br /> hwy 12 // lodi ► Ca att ;t1M <br /> 4 Generators Phone{ 209 ) 467-1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transponers Prone <br /> thrifty rooter 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 Facihiy s Phone <br /> lnvlro tec n/a 434-0211 <br /> 2480 athens ave . <br /> lzr_coln, ca <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> To,al Unit <br /> No Type Quan Ity �Wvvol <br /> a non ha-- waste liquid nos <br /> waste water 001 tt ad f <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> RI <br /> id I <br /> i <br /> I <br /> D Aedi c-al Descriptions for Wieienals Listed Abc%e E Handnng Ccoes for Wastes Listed Above <br /> purge vrater fr0M drums <br /> I <br /> i 6 Spccial candling Irs'rucoo-s and Aodi icnal Ii tic -a io, <br /> I <br /> en9 // troy r <br /> abeo // 916-826-3803 <br /> I I <br /> t <br /> I <br /> I <br /> 6 GENEPATOR S CERTIFICATION I ce^t y're rra e �";cescr Sed a^_�e on s ma fcsi e nei 4 ^ect to Icd- FI au a ions for eDering p ere o socLz r'h'axrrdo-s Jas e <br /> II Pn,tec7}ped Na-ne Signature 'Rorh O, y 1Far I <br /> I <br /> I _ <br /> I <br /> T k 17 Tianspo"er 1 Aci leduc-pert o, Feceiol 01 t lVe a s <br /> R <br /> A fnro'`c 7Iped Ilar;e e f J Mcnrh Day Year <br /> S 6119 Pe <br /> O 18 Transpc-er 2 AcKno%l ledgcmeri of Receipt of mate ka'q <br /> R - <br /> r Printeolyped Name i Signature Mon h Day Year <br /> E <br /> R <br /> 19 Discrii Indication Space <br /> F <br /> A <br /> C <br /> 20 Facility Cv ner or Operator Certi'ication of receipt o't%asie mate ia9s cote ed by this r^dnifest except as ndv_d-in Item 19 <br /> r ' Typ NAme Sig n e / - Lton ti Day 1 ear <br /> tAME].ho t ��--� r 6 19 Ic2 <br /> Printed by J J KELLER d ASSOCIATES INC 12-BLS-05 Rev 12198 <br /> Neenah WISCB57C36B TRANSPORTER #1 <br />