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12/12/03 FRI 07:46 FAX 6613914498 CHEVRON PIPE LINE KRNRVR 10007 <br /> L00Q� [C999 ON X21/Xll TO:ZT_LL Co/TT/ZT <br /> NON - HAZARDOUS WASTE MANIFEST <br /> PROFIUE <br /> NO-/,Po 0 5 <br /> 1-800-459-303fi <br /> E7 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 ----------- <br /> Name: <br /> ----- ---- IName: . �lEl/Avi/ )�i r'C<i ✓c <br /> 00 MallinglAddress : <br /> u tSAI_F�y/ i��y X 308 <br /> R1 City/Skate/Zip <br /> Phone No �� l ' 3`rl -SS.SD Contact: f/ u �rt^ycR <br /> Y P <br /> m Signature: X/� ::"•F'��-ski'%tet,- Date: <br /> W THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100% NON-HAZARDOUS <br /> Li <br /> d Waste Description ; /i�d"// t:r rP/1,•r L SJ L L/f >� j/t/5 <br /> UGenerating Location ; }� / L�Ee%25 e Z.f j r, L: i rc rJc r7 y <br /> m Handling Instructions <br /> O Quantity : ✓ C BBL C 1GLS C'1YDS C TONS <br /> CONTAINER TYPE, C ITANKTRUCK HDUMPTRUCK C DRUMS C 113INS C IMER <br /> DESIGNATED FACILITY <br /> i�L.'7' /l.c:j firADDRESS: <br /> NAME: � l' '���1�L <br /> IYSTATE2IP:.< PHONE# <br /> 1:393-1151 <br /> TICKET# tl TFIACT(rRLR# 6Ia '3130 <br /> 4CUUM TRUCK SERVICE <br /> PAVIRONMENTAL SERVICES, INC. Bin Nos <br /> SignatureManor Sffeet 93308 Date P/U DATE: !d-503 Job#Cr <br /> Name : Disposal Method : <br /> ❑Landfill Other <br /> Y <br /> Address1-1 : <br /> Ctty/State/Zip : <br /> V am <br /> lay Phone No: 71me : pm <br /> O <br /> Discrepancy: <br /> (•r <br /> 7jJ ,/ 2 <br /> Signatuire : f/ 5- Date : <br /> TRANSPORTER RETAIN <br /> ,__,a %V3 ZT:cT co/tT/ZT <br />