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NON-HAZARDOUS 1.Genentor's US EPA ID No, 2.Page 1 3,Document Number <br /> WASTE MANIFEST p 1 6511 <br /> 4.Generator's Name and Mailing Address <br /> rfon+icr Traal:r.r�l+tor, <br /> I�t,s Gant. itol <br /> Trolr.� e� �Sa°�I <br /> Generator's Phone <br /> 5.Transporter Company Name 5. US EPA ID Number 7.Transporter Phone <br /> CLEARWATER ENVIRONMENTAL CAR000007013 A51 0)476-1740 <br /> B.Designated Facility Name and Site Address P. US EPA ID Number 10.Facility's Phone <br /> ALVISO INDEPENDENT OIL <br /> 5002 ARCHER STREET <br /> ALVISO, CA 95002 CAL000161743 (510)476-1740 <br /> E 11.Waste Shipping Name and Description 12.Containers 13. 11. <br /> IN Total Unit <br /> E No. T Ouenti WWol <br /> A a. <br /> T Non-Hazardous waste 1) O �S <br /> 0 <br /> R b. <br /> /)0)J laPZOIla C) rs COPClt- -Solid <br /> 15.Special Handling Instructions and Additional Inlormeeon Handling Codes for Wastes Listed Above <br /> Wear PPE 17a 1lb <br /> Emergency Contact <br /> (510)476-1740 <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 /> PrintedrPryed Name Signature 7G^^� v <br /> NS jU� 0-V Oe 4p o f 6I!"e L /Ytitel/ `/ 0-it Q yea, <br /> S 17.Transporter Acknovdedgement of Recelpt of Materials <br /> P <br /> O Prntedrryped Name Signature <br /> R � )8rl< ) / M�th Day Yeer <br /> 18.Discrepancy Indication Space ll 1/N' / d— L <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I <br /> T <br /> Y <br /> 19.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted In Item 1e. <br /> Pdnted/Typed Name Slgnature <br /> 4 s_- Gha(_Jas Seu1onMonth1DZ 18h <br /> a'a^r7YE—ORIGINAL(Return tar Generator) YELLOW—TSOF(Robin Copy) FINK—TRANSPORTER COPY GOLDENROD -GENEHATOR'S COPY <br />