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®BBB rY1t or t� - <br /> ;�p[ilBSiQrIBd 6 '92yi11 Iy�BWr1t6G} <br /> NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST n/a 0001 lof 1 <br /> 3 Generators Name and Mailing Address <br /> cheveron <br /> hwy12 lodz , ca <br /> 4 Generators Phone( 209 467-1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> inviro tec n/a 434-0211 <br /> 7 Transporter 2 Company Name B US EPA ID Number B Transporters Phone t <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> inviro tec <br /> 280 athen ave <br /> lincoln , ca n/a 434-0211 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> PF 9 P Total Unit <br /> No Type Quantity WWot r <br /> a <br /> ' <br /> non haz waste liquzd 001 t � g <br /> waste water <br /> y <br /> F G b <br /> E �x <br /> c N <br /> E <br /> M R ;r <br /> is A c n <br /> O ' <br /> R <br /> f +A <br /> { <br /> r <br /> r - <br /> D Acd conal Descriptions for Via e ials Listed Above E Handling Coees for Wastes Lined Above <br /> purge water from tan': <br /> 5 Spec al 1-.noling Ins ructions and Additional Info r^.ion t <br /> r <br /> w - <br /> emerg = <br />� 1 abco troy w 916-826-3803 <br /> _4 <br /> .b GENERATOR 5 CERTIFICATION 1 re i'y e Tc e -Is descnbeC about or - G 'est a e no ;,t,ec o fcderzl regui..tons or rcpo�ing p cper d spoGal ci-iazG jo_s 4yas e <br /> Prin,eC+T uedf\arnE Ci^ 1 1 b ti tea) 1Ear <br />' x - <br /> T 17 I r nspo'e 1 Ackno��Icccernenl of Rece pt of V4; er a's <br /> R = are ��-- <br /> r c^ D-v rear <br /> A rnrrn ec,T,ped Narre s - <br /> N (�� — 1_ <br />' P r a a--�� d � - <br /> O 18 T anspo^er 2 AcKno leeccmeni of Receipt of Wale a's <br /> R <br /> T f onnteo'Ttiped Name I Sigri8Lre Ion Day Ye.r <br /> E <br /> R <br /> 19 Disc epancy Incica,icn Space <br /> F <br /> A <br /> C <br /> 7Y0 Facm y Caner or Operator CerMr cation of receipt of ti aste male ials coffered by this mandes except as noted in Item 19 <br /> h <br /> Pnnlec'T�ped Name 5�gnafure <br /> 1,40nDav Year <br /> Pnn ed by J J KELLER d ASSOCIATES INC 12-BLS-05 Rev 121/98 <br /> Neenah WI 54957-0368 ORIGINAL -- RETURN TO GENERATOR <br />