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12/12/03 FRI 07:40 FAX 6613914498 CHEVRON PIPE LINE HRNRVR U003 <br /> C00(A IC99ft ON xa/X,LI i0:Z1�1d, CO/TT/ZT <br /> NON - HAZARDOUS WASTE MANIFEST <br /> D t ?. <br /> ' PROFILE NO. /gyp 03 <br /> 1•B00-450-3036 <br /> O BAKERSFIELD O YOLO O PHOENIX <br /> NOTE, This form to be in lieu of the Toxic Substance Controls hazardous <br /> waste manifest.To be used for NON-HAZARDOUS WASTES only. <br /> r,—rr r�rr�r nv,�,rr..yrrrh..4,r►r`r�.-/r„` ,+,•—w�•�w,r.�.,.+r w.n.�r�+,�/.v rrrr,�.ry r+�r <br /> Name : <br /> It <br /> O Mailing Address /✓ �� <br /> � <br /> wCity/State/Zip <br /> Z G6./- 311 5d Contact : Tyr J�INiE• <br /> c5 Phone No = <br /> m Signature: /;"/i F Date: <br /> w THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100%NON-HAZARDOUS <br /> LU / alL>n ro/ ///fJNc TG[J e'1 I �!>6tS�✓� <br /> J Waste Description <br /> CL <br /> rm <br /> O Generating Location <br /> ...:.fib'J' 'IE iilfldU.s 1?'.�i�-1 1 edit•C 1--'i.a'.�'t)' . <br /> L3 <br /> wm Handling Instructions : N� <br /> 00Quantlty : ✓1Z1' E IBBL E JGLS Yl YDS E ]TONS <br /> CONTAINER TYPE: E ITANKTRUCK [N4DUMPTRUCK C ]DRUMS C ]BINS C ]OTHER <br /> DESIGNATED FACILITY : <br /> NAME: G7/��'evl� ` c 'ADDRESS: aa <br /> CITY/STATE/ZIP: l"/I ✓Fie���y'�a.� C-"/ 1d5��- •7PHONEn <br /> ¢ TICKET# TRACT/rRLR# <br /> MP VAA�CCUUM TRUCK SERVICE Bin No's <br /> Q MP ENVIRONN►ENTAL SERVICES, INC. Signature s .oi+ < .o'— <br /> a. 3400 Minor Street <br /> Z 3400 rigid, CA et Date ',/ r►'i O$S <br /> O <br /> . Q 895/ss3-1151 PIU DATE: ..)2 - �~ Job N <br /> Name : Disposal Method : <br /> Landfill Other <br /> Address <br /> Y <br /> j City/State/Zip : am <br /> Q Time : Pm <br /> Phone No: <br /> IL <br /> q <br /> Discrepancy : <br /> N <br /> F- <br /> -�. • • .��. ,ten! Date : / -- — -- <br /> Signature <br /> TRANSPORTER RETAIN <br /> XV3 90:CT L•0/TT/ZT <br />