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Pisase Print or type <br /> P f , <br /> (Form desipnetl or use ort Olde(12-pitch)typewriter <br /> 7 <br /> ,_ NOry.HAZARDOUS 1 Generators US EPA ID No Mandest Doc No 2 Page 1 <br /> WASTE MANIFEST n/a 0001 1 °f 1 <br /> 3 Generator s Name and Mailing Address <br /> k Cheveron <br /> hwy 12 , loth , ca att; tim <br /> a Generalors Phone( 209 46.7-1006 <br /> 5 Transposer 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> thrifty rooter n/a 434-0211 <br /> 7 Transposer 2 Company Name 8 US EPA ID Number B Transposer s Phone <br /> invlro tec <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facshtys Phone <br /> I <br /> ivvzro tec n/a 434-0211 <br /> 2480 athens ave <br /> lincoln , ca 95648 <br /> 11 Waste Shlppmg Name and Descriplson 12 Cortamers 13TcAat Unit <br /> No I Type Civanl ty WtNol <br /> a non haz waste liquid 001 tt <br /> haste ,rater G� <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A I c <br /> TI0 <br /> IR <br /> fd � <br /> i <br /> t <br /> I D Additioral DESCTIpI10n5 io Vaienale Llslbd Above E Handling Codes'or 5rdas'es Lisica Above <br /> _.Urtica Nater from tank <br /> I I <br /> ' +5 Spec at Honduno Ins roc icns and Addrlioral lWo rraricn <br /> eng //abco <br /> troy w,. 916-826-3803 <br /> I <br /> i <br /> I <br /> i6 GENERATOR 5 CERTIFICATION I cer- v kc e is dcscr Ced above or c an lest a e not s.b eci 10 Icde al eguldlions or reposing CNC c cposal o I-az..reo,c% e t+ <br /> crinicOrT%--ed Name I S gratu e !f„r <br /> i <br /> T I 17 Transpose ' ACkno leope^en Ci Reccip.of a's <br /> A -P-mtedT%cedName- <br /> IS Tran=oo-ter 2 Ackncxledgemunl ct Receipt of Maier L{s <br /> R <br /> TPrmled,TlPeo Name Slgna.ure 140^1h Dsv Year <br /> RI <br /> I <br /> 19 Discrepancy Indlcat,on Space <br /> F <br /> A <br /> C <br /> I <br /> L 20 Eacill) 0%V)Or or Ciperalo Ce^dicat on of rete pt 0'�tiasle materials cove ed by this mandesl except as noted in Lem 19 <br /> i <br /> Pnnled'Typed Name �ignatu 74or 0oy Year <br /> rnnled fly J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12-/98 <br /> WE ah WI 54957°358 <br /> TRANSPORTER 41 <br />