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1,Generator's US EPA ID No. 2.Page 1 3.Document Number <br /> NON-HAZARDOUS <br /> of <br /> WASTE MANIFEST 1 7641 <br /> 4.Generator's Name and Mailing Address <br /> "tier Transportation <br /> 1 425 Larch Rd <br /> Tracy, CA 95304 <br /> Generator's Phone <br /> I 5.Transporter Company Name 6. US EPA ID Number 7.Transporter Phone <br /> CLEARWATER ENVIRONMENTAL CAR000007013 510)476-1740 <br /> 8.Designated Facility Name and Site Address 9. US EPA ID Number 10.Facility's Phone <br /> ALVISO INDEPENDENT OIL <br /> 5002 ARCHER STREET <br /> G ALVISO, CA 95002 CAL000161743 1 (510) 476-1740 <br /> E 11.Waste Shipping Name and Description 12.Containers 13. 14. <br /> N Total Unit <br /> E No. Type Quantity WWot <br /> A a. / <br /> T Non-Hazardous waste C I U1 Q 'rrt 5�� <br /> 0 <br /> R b. <br /> I <br /> 15.Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> Wear PPE a. 111b. <br /> Emergency Contact <br /> (510)476.1740 <br /> Attn: Kirk Hayward <br /> 16.GENERATOR'S CERTIFICATION: I certify the materials described above on Ibis manifest are not subject to slate or federal regulations for reporting proper disposal of Hazardous Waste. <br /> Printed/Typed Name Signature <br /> H _ Manfh Day Year <br /> A o r_ S ,s <br /> N <br /> S 17.Transporter Acknowledgement of Receipt of Materials <br /> P Printed/Typed Name Signature <br /> R I <br /> T �f' � / �.� Month Day Yger <br /> R f l— GGG C/ l�tJ <br /> 18.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> II <br /> T <br /> Y 19.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in Item 18. <br /> Pdnled/Tyip/e-d Name(• Signature <br /> M�nfh <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />