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mse pp��rs�1 Or <br /> KNEW <br /> {Form dealpne� _uap 9ute t9 !7ypawrfteta> , �' <br /> NDN-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFESTof <br /> } <br /> 3 Generators Name and Madrng Address �- <br /> r cheveron hwy 12 <br /> o k , ca <br /> 4 Generator's Phone( 209 ) 467 1006 att - tim <br /> Y <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> InViro ter <br /> x <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone ¢� <br /> k 9 Designaled Facility Name and Site Address 10 US EPA ID Number C Facility is Phone <br /> inviro tec n/a 434-0211 <br /> 2480 athens ave �. <br /> a <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit $V <br /> No Type Quantity WtNol <br /> �r a non haz waste liquid 001 ttw9 7 <br /> 'U <br /> ��-) <br /> juste ater .� <br /> E b ` <br /> � <br /> � <br /> J IN <br /> R �� I <br /> A c 4 <br /> T L <br /> O ss <br /> w;c <br />{s d <br /> z <br /> r <br /> D Addil+oral Descrip+ions for tdaler als Listed Abo%e E Handling Codes for VAas es Listed Above <br /> purge water from tank <br /> F � C <br /> I, 15 Special I-anolmg Instructions and Adoil onal Inlorr-aiion <br /> r I <br /> Ir <br /> emerg <br /> abco troy w 916-826-3803 <br /> I <br /> i <br /> L16GENERATOR S CERTIFICATION I cer,i y he-a e s oFscrinL c 45c%e of h s rreri es a e nc suht@ci io rede al ree.i?Tions cr eoo^ing piope dpsposal ei Hezaidois 1 Jas e <br /> t'rinicdrT�Ded yr ne I S onr !✓orifi Dav ear <br /> I tJ <br /> T 17 Transpaner yGk ct IedCe!-'Ent of Peceipl Of t'a,e ass <br /> R <br /> ?r r'Pd/T pee N,r le <br /> ti' u e rr �r r rrea�r <br /> � P ray layaece,� <br /> O 8 Transponer 2.ckncwledgement of Receipt e1 Ma er a's l— <br /> R <br /> T Printco/Typed'dame Sig^arure 1✓or,h Day ear f <br /> EI - <br /> R <br /> 19 Discrepancy InmcaliOn Space <br /> F <br /> A <br /> C <br /> I <br /> L 20 Faaiily owner or Operalor Ceni'ication o1 receipt o`+ ase male ials co%e ed by this manifest except as noled in item 19 <br /> ItPnnledj} <br /> pEd Name Sign /� eror n Day Near <br /> Pnnted Dy J J KELLER 6 ASSOCIATES !NC <br /> Neenah M 54957 ossa 12-BLS-C6 ReV 12198 <br /> ORIGINAL - RETURN TO GENERATOR <br />