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12/12/03 FRI 07:58 FAX 66139"498 CHEVRON PIPE LINE K"VRVR 14015 <br /> 5T0Qtj [C999 ON XH/%SI TO:Z� JH1 CO/TT/ZT <br /> NON - HAZARDOUS _ VyASTE MAN-LFEST <br /> PROFILE NO. U 12 J1 <br /> 9160 &30.36 /,7-04-)o <br /> ❑ BnKER3FIELD ❑ 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 /> /„r r.,K-vin,-,/N�//r��/- .vw,.rY�M1tit•nn/rti1-,w1,Vtir�1�-------------- -,n---- <br /> Name': <br /> Mailing Address ; /)�(r <br /> Q <br /> Z City/State/Zip <br /> w <br /> GS Phone No -);,-Y 2Ao I CX- <br /> /�/�- 3'-"r/ -4i,5'-o Contact <br /> m Signature: K f'�;� /�40 .c Date: <br /> WTHE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100%NON-HAZAgDOUS <br /> Description <br /> Waste <br /> � • s/.G T-l.? �>CI L l-: �1JC crKi 5 __ <br /> VGenerating Location : /VIP YZ444+Aro'5 4Y_&I 17 sem£ — r cy <br /> w <br /> M Handling instructions <br /> O <br /> ~ Quantity : -a.y C J BBL C I GLS C 'KJ YDS C ]TONS <br /> CONTAINER TYPE: E }TANKTRUCK E ODUMPTRUCK C ]DRUMS E BINS C ]OTHER <br /> DESIGNATED FACILITY: <br /> NAME: FiG 7X.r r/.n` %rriul)l�t r. ADDRESS: 19rIP QFC-:ir.ri;:.vi ���� .C:^� <br /> CITY/9TATEJZIP: � .�/se-G G.f ^.xi30- •a`-+.l,�l PHONEn : �.%•�� - -5 5 - �3�v <br /> MP VACUUM TRUCK SERVICE TICKETft c': ' ' TRACT/TRLR# / <br /> Q MP-ENVIRONMENTAL SERVICES, INC. Bin No's <br /> CL 3400 Manor Street Signature: , <br /> W Bakersheld, CA 93308 Data <br /> 605/393.1151 <br /> P/U DATE•. Job 4 <br /> 1-- <br /> I <br /> Name: Disposal Method <br /> Address : Landfill Other <br /> City/StMe/Zip : <br /> V , <br /> a _ am <br /> Time: <br /> pm <br /> y Discrepancy <br /> Signature : Date : /r <br /> T <br /> aTn 1M TRANSFORTER RETAIN py,, T7PT rn/TT/>T <br />