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s Mali prod OF <br /> jF�rm designed ese a Ee(12p )tYPamtter�. r <br /> NON-HAZARDOUS 1 Generators US EPA tD No Manifest Doc No 2 Page t <br /> WASTE MANIFEST n/a 0001 1 of 1 <br /> 3 Generators Name and Mailing Address <br /> r CHEVERON att tim <br /> HIITY12 ' lode , ca <br /> 4 Generators Phone( 209 ) 467 1006 <br /> t 5 Transporter 1 Company Name 6 US EPA 0 Number A Transporters Phone <br /> INVIRO TEC n/a 434-0211 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter s Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA 0 Number C Facilrtys Phone <br /> INVIRO TEC <br /> 2480 athens ave <br /> lincoln , ca 95648 n/a 434-0211 <br /> 13 14 <br /> 11 Waste Shipping Name and Description 12 Containers Total Unit P <br /> No Type Quantity Wt/Vol <br /> a non haz waste liquid nos 001 tt a r <br /> waste crater- <br /> G b <br /> E *� <br /> E <br /> R �� <br /> A c <br /> T <br /> O ? <br /> R to <br /> M <br /> d <br /> r^ <br /> F <br /> t D Acdiiional Desc ip,rons fo Mp enals Ls,ed Above E Handling Codes for Wastes Lisred Above <br /> E purge water from tank <br /> f• ! <br /> r, -a <br /> r <br /> 1 15 Special Hendlrng Ins,rucalons and ADO,onal InlorTa ion t <br /> 1 i <br /> I - <br /> emge abco TROY 916-826-3803 <br /> i - <br /> i <br />` i6 GENERATOR S CERTIFICATION I ce-,Iyaeacri-eC a5o.c c- `is m2r,ie=t 2 e nc sLrten to ece tl ieg,Ja ions for repor n_nroper d sao=d of Hezardas.+aste <br /> t l Pr^ted T4DL Iame r' fro Day 1 ear <br /> �Jj <br /> R i 17 Tianspertet 1 Ackno+�reogernent of receipt of 1,1a er a's <br /> A Prin,edr7yped Name re Vooq h Day 1^ r <br /> _ <br /> Sl RAY LLOYDS ! r a�� <br /> L P <br /> O 1 8 Transporter 2 Acknov ledoernent of Receipt of f is^e ia's _ <br /> R i MD;rn Da Yeor <br /> T Pnnted/T�ped Narre ! S gnct�re � <br /> E i <br />' R i <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> I <br /> L 20 Facdrly O%+rer or Operator Certrlication 0 receipt C' tias,e ma,enals co�eree by,his man'est except as noted in Ilem 19 <br /> PrinleelT4ped Name Si tion h Dav Year <br /> Printed by J J KELLER&ASSOCIATES ;NC <br /> Neenah Wi5a957 D368 12-BLS-05 Rev 12198 <br /> ORIGINAL -- RETURN TO GENERATOR <br />