Laserfiche WebLink
d <br /> NON-HAZARDOUS 1 Generators US EPA ID No 2 Page 1 3 Document Number <br /> i WASTE MANIFEST of 1 NH— _ 487a <br /> 4 Gpnerator s Name aQd Mailing tddres <br /> L'31 <br /> Generator s Phone r & 41 fk_CZ 2'�' <br /> 5 Transporter CoMpany Name 6 US EPA ID Number 7 Transporter Phone <br /> L CLEARWAT 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 CALD00161743 (510) 797-8511 <br /> N 11 Waste Shipping Name and Descnption 12 Containers 13 14 <br /> tal Unit <br /> iit <br /> E No T e Quantity WWol <br /> R a <br /> T Non-Hazardous waste, liquid <br /> 0 001 TT G <br /> R b <br /> 15 Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> Wear PPE 11b <br /> Emergency Contact <br /> (510) 797-8511 <br /> Attn Kirk Hayward <br /> a <br /> 16 GENERATOR'S CERTIFICATION I certify the materials described above on this manifest are not subject to state or federal regulations for reporting proper disposal of Hazardous Waste <br /> Printed/Typed Namet Signature �, <br /> T iF t3 r Nei r � ` -^"""` A -vN+ ;I-p Month Day Year <br /> N <br /> S 17 Transporter Acknowledgement of Receipt of Mdledals <br /> P Pnntedrryped Name Signature - <br /> 0 <br /> R �` Month }Day Yea <br /> R i / i i / fZF'ij `f: �giF.ty s efE.f Irl <br /> l <br /> 18rscr panW1' dicaiion Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> ` T <br /> 19 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 1 B <br /> Pnntedrryped Name Signature <br /> Month Day Year <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retaln Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERA'TOR'S COPY <br />