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1.Generator's US.EPA ID No.. , 2.Page 1 3.Document Number <br /> . : w.,. NONHAZARDOUS <br /> WAST j of <br /> ` a 1IFEST ;: 1 NH- <br /> 0. <br /> r <br /> krjtator's <br /> r <br /> Name <br /> I�nSM <br /> r <br /> .tit�.�lii•,�J...{l ftKtt 14 [i;wo I;tI 1<i :lIN" f� t`I•3; <br /> �Generatohonekrk � . yr •� �' <br /> 5.T 'offer gp�paFspYFCai e, 6. US EPA ID Number 7.Transporter Phone <br /> _': gyp. <br /> CLEA . VIRONMENTAL CARD00007013 (510) 797-8511 <br /> 8,Designated Facility Name and Site Address 9. US EPA ID Number 14,Facility's Phc,ne <br /> ALVISO INDEPENDENT OIL <br /> 5002 ARCHER STREET <br /> G ALVISO, CA 95002 CAL000161743 (510) 797-8511 <br /> E <br /> N 11.Waste Shipping Name and Description . 12,Containers 13. r 14. <br /> E Total <br /> WtNol <br /> aA No. Type <br /> T Non-Hazardous waste, liquid <br /> o. 001 TT6W G <br /> I b <br /> 15-Special Handling Instructions and Additional Information. Handling Codes for Wastes Listed Above <br /> Wear:PPE Ila, 11b. I <br /> i . <br /> Emergency Contact <br /> (510) 797-8511' <br /> I; Attn: Kirk Hayward <br /> 16.GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject io state or federal regulations for reporting proper disposal of'Hazardous Waste, " <br /> Printed/Typed Name Signature <br /> R ! F _sus' yn f Month Day Year <br /> f` f` V f <br /> _= i 1 'C. L ` I 1�i ..r �„i�;C.iJ i v- f- (�� �a:a '"� �-�L!;r,r '�:2 r! i, t <br /> S 17.Transporter Acknowledgement at Receipt of Materials - <br /> p PrintedlTyped Name Signature <br /> R <br /> T t_ Morith Day Year <br /> li T"t J f <br /> 18.Discrepancy indication Space <br /> f <br /> +� ,F <br /> A <br /> I �. � .. <br /> 19.Facility Owner or Operator:Certification of receipt of.waste materials covered by this manifest except as noted in item 18. <br /> Printed/TypedName Signature <br /> r , <br /> Month Day Year 1 <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />