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12/12/03 FRI 08:04 FAX 6613914198 CHEVRON PIPE LINE KPNRVR laoi 9 <br /> vola IC998 ON YH/%7,1 w z: AH1 CO/TT/ZT ..i <br /> NON - HAZARDOUS WASTE MANIFEST <br /> X <br /> PROFILE NO. 37 <br /> 1-800-458-3038 <br /> ❑ BAKERSFIELD ❑ 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 /> Name : <br /> Er <br /> 0 MaillnigAddress : <br /> Z <br /> w City/State/Zip: �SkEx �i,Et ,� , �A - <br /> tZy <br /> (7 Phone No - a`9/'^ `� Contact <br /> M Signature: X Date: <br /> O <br /> LLJ H THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100% NON-HAZARDOUS <br /> LU <br /> a <br /> Waste Description : 1�j��^�Gl°re'v� irtr3'� 0 :5 "A7. <br /> D Generating Location : • •%�` X/C��p•..'�'S N_ r r'.,'cG :.•rT .•r;�y <br /> U <br /> Lu <br /> Handling Instructions : '✓"�E <br /> O <br /> ~ Quantity : I JBBL I IGLS YDS I )TONS <br /> CONTAINER TYPE: I 7TANKTRUCK CIDUMPTRUCK C ]DRUMS E 113INS C 10THER <br /> DESIIGNATED FACILITY : <br /> tNAE: •'jLY�/a!t.Ji 1rt,yJ7r/« ADDRESS : <br /> STATE/ZIP: •/` v'E.t'f,irftE , ,�,.t is!�:U— Sew: PHONE# 9=•' �5�• 7goo <br /> CC Nf1CUUM TRUCK SERVICE TICKET# _7a6TRACTfrRLR#ENVIRONMENTAL SERVICES, INC. Bin No's I Ianor Street Signature•rsfield, GA ®3306 ate <br /> 3931151 PIU DATE: 1•` ' U 3 Job# <br /> Name.: Disposal Method <br /> Address'; ElLandfill Other <br /> I— <br /> :3 Clty/$tate/Zip <br /> U <br /> LL Phone No : Time : am <br /> N <br /> Discrepancy : <br /> F <br /> Signature : Date <br /> aTn Fiii TMANCPno!=M"TAIM vv.r n. nr n.. .++ :+• <br />