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n i <br /> I Generator's US EPA ID No 2 Page 1 3 Document Number <br /> NON-HAZARDOUS <br /> WASTE MANIFEST of 1 NH— 46875 <br /> 4}n{Generator's Name <br /> j}and <br /> �Mailing Address j 11 ` psi;SS- <br /> !�i y r}}a it � r�f �15� • II rl 1'slj STf ,1 fjY�4�r�1 <br /> Generator s Phone j'2 2 <br /> 5 Transporter Company Name 6 US EPA ID Number 7 Transporter Phone <br /> CLEARWATER ENVIRONMENTAL CAR000007013 (510) 797-8511 <br /> 8 Designated Facility Name and Site Address 9 US EPA ID Number 10 Facility's Phc,ne <br /> ALVISO INDEPENDENT OIL <br /> 5002 ARCHER STREET <br /> G ALVISO, CA 95002 CAL000161743 (510) 797-8511 <br /> N11 Waste Shipping Name and Description 12 Containers Tot14 <br /> al <br /> E No Type Quantity wwol <br /> R a <br /> T Non-Hazardous waste, liquid <br /> O 001 TT G <br /> R b <br /> 15 Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> Wear PPE 11a 11b <br /> Emergency Contact <br /> (510) 797-8511 <br /> Attn Kirk Hayward <br /> 16 GENERATOR'S CERTIFICATION I certify the materials descobed above on this manifest are not subject to state or federal regulations for reporting proper disposal of Hazardous Waste <br /> Pnntedrryped Name Signature L\1 <br /> R tY Morrth rCl�ay Year <br /> t L <br /> 5 17 Transporter Acicnowledg4ment of Receipt of Materials <br /> P <br /> O Printed/Typed Name Signature <br /> R <br /> T f+ `�a�, y` Month Day Year <br /> E <br /> 18 Discrepancy Indication Space Y <br /> F <br /> A <br /> C <br /> I <br /> L - <br /> 1 <br /> 19 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 18 <br /> Printed/Typed Name Signature <br /> MonthDay Year <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(R'#tain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />