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Please or a r <br /> NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Pagel <br /> WASTE MANIFEST I n/a 10001 1 of 1 <br /> 3 Generators Name and Marling Address <br /> cheveron r ` <br /> G <br /> hwy 12 lode , ca att TIMM <br /> 4 Generators Phone( 209 ) 467 1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transposers Phone <br /> znviro tec n/a 434-0211 <br /> 7 Transposer 2 Company Name 8 US EPA ID Number B Transposers Phoney <br /> J <br /> 9 Designated Facility Name and Site Address 10 US EPA 1D Number C Facility s Phone <br /> - inviro tec <br /> 2480 athen ave <br /> 1incoln , ca 95648 n/a 434- 021113 11 Waste Shipping Name and Description 12 Containers Total 14nitr <br /> No Type Ouanlity Wt/Vol <br /> a <br /> tri non haz waste liquid nos <br /> waste water 001 tt qx <br /> G b ' <br /> ` E S� <br /> r s <br /> N er^ <br /> E - <br /> R <br /> w A c <br /> T { <br /> a <br /> R js <br /> t <br /> d r" <br /> t` <br /> f <br /> D Additional Descriptions for Vatenals Listed Above E Handling Godes for vv as,es L s'ed Above <br /> r <br /> r -r <br />€ <br /> 15 Specicl Handling 4rstructions and Adoitional Informaocn <br /> I emergency abco troll 916-826-3803 <br /> fl�, <br /> r � <br /> i - <br /> r � _ <br /> 16 GENERATOR S CERTIFICATION I ce^,ly,ne na' cit descr wed beve on r-ar'e=i are no,s iec Ic feacrol cci,la.o,e for epor ne p o-c drsposai of Ha2creous 5".s e <br /> i I Pri-ec7lpac+Ncme 11eri1h D..y 5E8r <br /> LL 3'Vl <br /> T 17 Transporter 1 4 Krcwled(jc-rCr1 of Peceipt of ,lz:e a's <br /> A PnnleC,irped Name ., <br /> S RAY LOYDE «-- <br /> P —d- <br /> 0 <br /> 18 Tra-ispor,er 2 AcknoMeogement of Receipt of t1a era's <br /> T Pnnt�a/'T)ped Name Slgna,ure Monh tDav Year <br /> E - <br /> R <br /> i <br /> 19 Discrepancy Ireicaiior,Space <br /> i F <br /> A <br /> C <br /> I ' <br /> E20 Facility Or ne or Operator Ce~uncation of receipt o'% as,e materials cove ed by this manifest excep'as noted in I em 19 <br /> E- - 140rn h Da <br /> Print ped NameSiar- y }Ear <br /> Printed by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12198 <br /> Neenah WI 54957 0368 <br /> ORIGINAL — RETURN TO GENERATOR <br />