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12/12/03 FRI 08:01 FAX 661391A-498 CHEVRON PIPE LINE K"RVR 0017 <br /> LTOIn rc999 ON XN/XJ:I To:z,� 90/TT/ZT <br /> NON - HAZARDOUS WASTE MANIFEST <br /> PROFILE NO. In 230:;8; <br /> 1800.458 /ar>07 <br /> ❑ BAKERSFIELO ❑ 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 /> Name : <br /> nly-Name : C f! xLaN <br /> m <br /> OF Mailing Address : -/-'�1/� :°1-/,yrl E/��r'�>,; ,i oaf <br /> a <br /> W City/State/Zip : +.)At'G,YSri4:4- 2_4 =733GrY <br /> a <br /> LA <br /> fS PhoneiNo r777 r Contact : <br /> m Signatures X-141- _y- ! D >,kxyr / Date: / / 0 5 / �>3 <br /> w THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 1000/. NON-HAZARDOUS <br /> w / <br /> Waste iDescription : /N.:.> :=.r/,.L:r3G,✓ Aa�%d�s7,Cy ��»: :�/! r>L Sf_. ; <br /> O Generating Location : <br /> U <br /> W Handli6l g Instructions <br /> O Quantity: �' D C ]BBL C ]GLS C "J YDS C ]TONS <br /> CONTAINER TYPE: C ]TANKTRUCK [ IbUMPTRUCK C ]DRUMS C DBiNs C ]OTHER <br /> DESIGNATED FACILITY : <br /> GTf1 /O YT �/tULJj-;AZ /✓}° D .lG>tS[iy.:TJ%!SS <br /> NAME: >t' ADDRESS : <br /> CITY/5t-ATE21P:.-�' yG;e,tr'o�t�: vIy j43;SJ7- ;y 3 PHONE Y.Er `i•5-�-!s_. -- '91�/-'0 <br /> cc <br /> Lu <br /> MP VACUUM TRUCK SERVICE TICKET# 2-5 72 6TRACT/rRLR# <br /> MP ENVIRONMENTAL SERVICES, INC, Bin No's <br /> d 3400 Manor Street Signature: <br /> Z Bakamdald,CA 93308 Date10, <br /> Q <br /> 805/.393-1151 PIU DATE: <br /> tL <br /> F <br /> I <br /> Name: Disposal Method : <br /> Address : ❑Landtni Other <br /> City/State/Zip : <br /> 3 <br /> LL Phone No : Time : Pm <br /> N Discrepancy : <br /> H <br /> Signature : .-_. � Date <br /> ,r�� TRANSPORTER RETAIN <br />