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12/12/03 FRI 07:43 FAX 6613914498 CHEVRON PIPE LINE KRNRVR Z005 <br /> 9001A rC999 ON %2I/%S,1 TO:Z1' 111 CO/TT/ZT <br /> NON - HAZARDOUS WASTE MANIF'EST' <br /> 94 p � ., <br /> PROFILE NO. <br /> 1•B00-458038 <br /> ❑ BAKERSFIELD ❑YOLO ❑ 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 /> rrrr r�/r-Vr --------- . --- ---rte.r r.urrr <br /> Name : <br /> C!AIL I,,1d <br /> 4 Mailing Address : �� �� '/"! v J SFA t 4i Ga' <br /> a <br /> W City/State/Zip : f3A�e.�-7 F//'c Z2 r � A r%3 Cs y <br /> LU <br /> Phone No 5�J/ - ;F 37?5 Contact : <br /> M Signature: X _� h ri - Date: 1-2 <br /> W THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100% NON-HAZARDOUS <br /> F- <br /> nJ Waste Description ; /-/Ns> s c �!rL 3;�/ 1, - " '• ry/ i % ve <br /> tQ.1 Generating Location : <br /> w <br /> M Handling Instnictions : IL 1WA <br /> O <br /> Quantity C IBBL C 1GLS 1'1�aYDS C TONS <br /> CONTAINER TYPE: C JTANKTRUCK [>5DUMPTRUGK 'C JDRUMS C ]SINS C ]OTHER <br /> DESIGNATED FACILITY : <br /> NAME;' ADDRESS: /['' rain L�r-r�ir n.• 7' %! lar <br /> CITY/STATE2IP: / l Vf"+�.I/d/.i , GJ %44;02` �iJL_2 PHONE # <br /> W TICKET#' �7/ TRACT/TRLR# <br /> 1— MP VACUUM TRUCK SERVICE _ <br /> 0 MP ENVIRONMENTAL SERVICES, INC, 9InN0e Roa rbc <br /> 3400 Manor Street Signature: <br /> N BakersflMd,CA 93308 Date 1.7 S' n <br /> Q 8051393-1151 P/U DATE: �• - r'--dT Job# -- <br /> Name : Disposal Method : <br /> Landfill Other - <br /> Address <br /> City/Ste(tatzlp <br /> U am <br /> LL Phone No : Time : pm <br /> p Discrepancy <br /> U) <br /> H <br /> i <br /> Signature : b Y /r •T---, _ _ _ Date <br /> TRANSPORTER RETAIN <br />