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NONHAZARDOUS 1.Generator's US EPA ID No. 2.Page 1 3.Document Number <br /> of <br /> WASTE MANIFEST _~ 1 NH -45442 <br /> 4.Generator's Name and Mailing Address <br /> ,Generator's Phone <br /> 5.Jransporter 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 8. 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 /> N 11Waste Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> E No. I T e Quantity W Wol <br /> d. <br /> R a. . <br /> A ,a""w• .,ti.z• <br /> o Non-Hazardous waste, liquid _, 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 described above on this manifest are not subject to state or federal regulations for reporting proper disposal of Hazardous Waste. <br /> PrintedlTyped Name Signature <br /> ' h ' Month Day Year <br /> A ,4a,:� ..�v <br /> N <br /> S 17.Transporter Acknowledgement of Receipt of Materials <br /> P Printed/Typed Name Signature <br /> Month D$y Year <br /> RE <br /> 18.Discrepancy Indication Space / r <br /> i <br /> P <br /> A <br /> C <br /> L i <br /> T - <br /> 19.Facility Owner or Operator;Certification of receipt of waste materials covered by this manifest except as noted in Item 18. <br /> k Printed(Typed Name .•� .., .x; Signature <br /> s <br /> ' Month Day Year <br /> WHrM—ORIGINAL(Retum to Generator) 'YELLOW—TSDF(Retain Copp) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />