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Generator's US EPA ID No. 2.Page 1 3.Document Number <br /> NON-HAZARDOUS <br /> of <br /> WASTE MANIFEST 1 7C Lj <br /> 4.Generator's Name and Melling Address <br /> tier Transportation <br /> 425 Larch Rd <br /> Tracy, CA 95304 <br /> Generator's Phone <br /> 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 (510)476-1740 <br /> E 11.Waste Shipping Name and Description 12.Containers 13. 14. <br /> N Total Unit <br /> E No. 11T a Quantity WWol <br /> In <br /> A a <br /> r Non-Hazardous waste I cl U] D 7 Q� SSS <br /> 0 <br /> R b. <br /> 15.SWIM Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> Wear PPE a 11b <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 slate or federal regulations for reporting proper disposal of Hazardous Waste. <br /> P intednWed Name Signature <br /> TR � - Month Day Yeer <br /> A <br /> N <br /> S 17.Transporter Acknowledgement of Receipt of Materials <br /> P Printed/rypad Nam Signature <br /> O <br /> E (1/A / �' (J �I Y' � Monrh Day Y@ef <br /> E 'V bb , n'� GG CC W <br /> 18.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> ( I <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 /> PdnterDTyped Name Signature <br /> Mgnlh Day_ DYeer <br /> f��Ilcsl��n VL. T7 Ci <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />