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NON-HAZARDOUS 1 Generator's US EPA ID No 2 Page 1 3 Document Number <br /> WASTE MANIFEST of 1 NH- 2 45437 <br /> 4 Generator s Name and Mailing Address <br /> f �^ _ < <br /> Generators Phone <br /> 5 Transporter Company Name 6 US EPA ID Number 7 Transporter Phone <br /> CLEARWATER ENVIRONMENTAL CAR000007013 (510) 797-8511 <br /> 8 Designated Facahty 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) 797-8511 <br /> E 11 Waste Shipping Name and Descnpton 12 Containers 13 14 <br /> N Tota! Unit <br /> E No a QuantWVVoI <br /> R a <br /> T Non-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 <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 /> Printed/Typed Name Signature <br /> T Monlh Ray Iyea r <br /> t <br /> R t3 s ` r �;` L E1,h1�• <br /> A t v ) _ r r` s , <br /> N <br /> S 17 Transporter Acknowledgement of Receipt of Materials <br /> PO PnntedfTyped Name Signature <br /> R <br /> Mo01h Aa Year <br /> 18 Discrepancy Indication Space f <br /> r <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 /> Printed/Typed Name Signature <br /> Month Day Year <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) — PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />