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REc��v <br /> NON HAZARDOUS 1 Generators US EPA ID No 2 Page 1 3 Document Number <br /> of NH— y_ 46877 <br /> WASTE MANIFEST 1 <br /> Q Generator s Name and ailing A dress i_ <br /> ATmI P �[ �� 12�y VnirAiM LV_ <br /> Generators Phon `1 1 <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 Facilitys Phc ne <br /> ALVISO INDEPENDENT OIL <br /> 5002 ARCHER STREET <br /> G ALVISO, CA 95002 CAL000161743 (510) 797-8511 <br /> N 11 Waste Shipping Name and Description 12 Containers 13 14 tel Unit <br /> E No Type Quantity WtNol <br /> R a <br /> T Nan-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 11a 11b <br /> Emergency Contact 8 <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 /> if Printed/Typed Name Signature , r� <br /> T {{ 9✓ . �— Month Day Year <br /> A Flo fieS T l iC C �a <br /> N <br /> S 17 Transporter Acknowledgement of Receipt of Materials <br /> P <br /> 0 Pnnted/Typed Name Signaturay <br /> R <br /> T th D year <br /> R !� <br /> 18 Discrepancy Indication Space <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 thiVtI1@nifest AcepWs noted in Item 18 <br /> PnntedlType me � Sigpature <br /> �J L fl n[ Day Y I <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />