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12/12/03 FRI 07:49 FAX 661391 "498 CHEVRON PIPE LINE KPNRVR [a 009 <br /> 60012 IC999 ON X-d/XZI TO:Z, .1115 C0/TI/ZT <br /> NON - HAZARDOUS WASTE MAN) FBST <br /> i <br /> PROFILE NO.— __� ' <br /> L0d59- <br /> 803036 - , <br /> ❑ BAKERSFIELD ❑ YOLO ❑ PHOENIX <br /> NOTA: This form to be in lieu of the Toxic Substance Controls hazardous <br /> waste manifest.To be used for NON-HAZARDOUS WASTES only. <br /> Name : i' f/�v,,�nn/ <br /> !t <br /> OF Mailing Address : / y 4 ' ,VJ V.4 <br /> a <br /> W City/State/zip: t�'ft,cs;rc�l'. ' c r�, •�! �3CJ f2 <br /> Z <br /> w <br /> C7 Phone.No Contact: <br /> m Signature: X ,!_f % o Date: / / n• / o <br /> W THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100% NON-HAZARDOUS <br /> l- <br /> L4 Waste:Description _ %w ern " t a Ira s'> �• 4 iv/ ir:sa A <br /> CL <br /> / <br /> Generating Location , P E'[A <br /> m Handling Instructions <br /> O <br /> Quantity: +?,� C I BBL C I GLS C YDS C TONS <br /> CONTAINER TYPE: C ]TANK TRUCK C%'7DUMPTRUCK C ]DRUMS C ]BINS C 10THER <br /> DESIGNATED FACILITY <br /> L: NAME: 4Z r4 rir:N•r l gNril il_[ _ _ ADDRESS': - ��557(' /(/ >:4,tiai�' �i's••3 x:;, <br /> CITY/STATE0 : �l YFir.:.t!/1'[. 'l5/3�G- 74:>PHONE A <br /> 2 <br /> w673 / 3l7r <br /> H MP VACUUM TRUCK SERVICE TicKET#NQts2%5{ TRACT/TREK# <br /> Q Bin No's - <br /> O MP ENVIRONMENTAL SERVICES, INC, I. �.;, <br /> 3400 Manor Street Signature: •� <br /> WBakersfield, CA 93308 Date 11 5 r t <br /> Z <br /> 605/393-1151 <br /> a P/UDATE: r, 5-q3 Job <br /> Q <br /> F- <br /> Name : Disposal Method: <br /> >> Address: ❑Landfill Other <br /> h <br /> City/State/Zip <br /> U <br /> lay Phone,No : Time : am <br /> pm <br /> C1 Discrepancy : <br /> rn <br /> r <br /> Signatbre - Date : -.-- <br /> I <br /> VIIIII <br /> n^^� Ta eNep(�g7•rR RCTaiN <br /> YV.d bi:ET EO/TT/ZI <br />