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r::::.{+.: ...r c- -..�.�:::.:.:: ,i - i.. .... lv,_�.._ •-. _ ._ __.._r.., r.... ..�ierr-._r ri.�....-r � .__ -...�v�ss��,�r»._. ... _ ..-._......,..._. <br /> 1.Generator's US EPA ID No. 2.Page 1 3.Document Number <br /> NON-HAZARDOUS i <br /> WASTE MANIFEST of 1 N H— 45436 <br /> 4.Generator's Name and Mailing Address <br /> Generator'sPhonq <br /> 5.Transporter Company Name 6. US EPA ID Number 7.Transporter Phone <br /> CLEARWATER ENVIRONMENTAL CAR000007013 (510) 797-8511 <br /> S.Designated Facility Name and Site Address 9. US EPA ID Number 10.Facility's Phone <br /> ALVISO INDEPENDENT OIL <br /> 5002 ARCHER STREET <br /> G ALVISO, CA 95002 CAL000161743 (510) 797-8511 <br /> E 11.Waste Shipping Name and Description 12.Containers 13. 14. <br /> N Total Unit <br /> E No. Two Ouanti WI/Vol <br /> R a. <br /> T Non-Hazardous waste, liquid <br /> 0 001 TT —� G <br /> R b <br /> a <br /> 15.Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> Wear PPE 11a. 11b. <br /> l <br /> Emergency Contact <br /> (510) 797-8511 <br /> Attn: kirk Hayward <br /> i <br /> 16.GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject to slate or federal regulations for reporting proper disposal of Hazardous Waste. <br /> Printed/Typed Name Signature <br /> T Month Day Year <br /> R <br /> N <br /> S 17.Transporter Acknowledgement of Receipt of Materials <br /> P Printedfr ee&,,{V=e Signature <br /> R �ar <br /> T ter, # r,r . . Moir th Day Year <br /> "'' ' ` <br /> R .y <br /> 16.Discrepancy Indication Space f� <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I <br /> _.T <br /> 19.Facility Owner or Operator:Certification of receipt of waste materials covered by this manilest except as noted In Item Is. <br /> Printedfryped Name Signature <br /> Month Day Year <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSOF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />