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PJeese pnnt or type ` s e _ IL <br /> t _ <br /> {Form designed for use on Blee(12-pitch)typewriter) <br /> NON-HAZARDOUS 1 Generators US EPA ID No fdlaniresl Doc No 2 Page 1 <br /> WASTE MANIFEST n/a 00001 1 of 1 <br /> I 3 Generators Name and Mailing Address <br /> cheveron <br /> hwy 12// Jodi , ca att : tlm <br /> 4 Generator s Phone( ) <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter s Phone <br /> thrxft rooter n/a 916-434-0211 <br /> 7 Transposer 2 Company Name a US EPA JD Number B Transporters Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> xnvxro tec <br /> 2480 athiens ave . <br /> lincaln , ca n/a 434--01211 <br /> 11 1'1'asle Shipping Name and Description 12 Containers 13 4 <br /> Total Unit <br /> No Type Ouanlily .,t'Vol <br /> a <br /> non haz waste ligUid nos 001 tt 2800 gal . <br /> waste watar <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> I <br /> A c I <br /> T <br /> O <br /> R <br /> I <br /> I <br /> I rD Acdioonal De,,cnptiors for V-a ia�s Lis'cd Abotie E Nordling Codes to Wa5Les L 5 cd Above <br /> �urre grater from tank <br /> ! <br /> I <br /> 5 Srea-1 Nanoline In51rLCIic-tS�-6 rdd atonal ir'or'-F nn <br /> ! ?'-Ig /// a Oco <br /> tray 17 916-826-3803 <br /> i <br /> f <br /> I _ <br /> 16 GENEPATOR S CERTIFICATION I eri Fe ce =e= C,e cr -t--;n lccl eic S tfect tc'Coc al _au a io-s or Fpon.o p o,,-er d s o al o'1-JaZ�rde..s e <br /> Printed Tvped Name S c^a v e 110,5 Lav Yesr <br /> T 117 Transporer 1 Acknc lecceme^.of Reccipt 01 Ira- 3 5 <br /> R <br /> NPn^.ed7�ped Na-re <br /> 'G�I�P_n-zn ' '� / <br /> P � "_�L�fl� ram--'r � . <br /> Ri 18 Transposer 2 ACKre% IeccEmeri of Receipt of rs4aie vu's <br /> T Pnntedi7vped Name Sig-,a u e _ r o h L'sy tea, <br /> E <br /> R <br /> i 9 Discrepancy Indecalion Space <br /> I <br /> F <br /> A <br /> C <br /> I <br /> L 20 Facility Oxner or Opera er Cer,i ica ort o1 iece p o'%N3SLe m2 en8IS Cc%erec by this mcniles�except as noted in Item 19 <br /> Printed,Ttped Narr ,Signature: - % �J Moir Dov scar <br /> Pr<nted by J J KELLER& SSOCIATES INC <br /> Neenah WI 54957 0368 12-BLS-05 Rev 12198 <br /> TRANSPORTER #1 <br />