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f <br /> 1 Generators US EPA ID No 2 Page 1 3 Document Number <br /> NON-HAZARDOUS <br /> WASTE MANIFEST �t 1 NH- ° 47186 <br /> 4 Gren�jatar Name an ailing A dress ��t { <br /> Y1t L::l Cly i�' � li�Ti, ��a lam_ 3Ylid <br /> 115so U G.A �.Itvv T3' ,I'L ��,sJ <br /> 'iL;Alrr4 '-A. T_'21q <br /> Generator s Phone i — I <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 Facility s Ph6ne <br /> ALVISO INDEPENDENT OIL <br /> 5002 ARCHER STREET <br /> G ALVISO, CA 95002 CAL000161743 (510) 797-8511 <br /> N 11 Waste Shipping Name and Descnption 12 Containers 13 14 <br /> Total Unit <br /> E <br /> No Tvoe Quanta Wt/Vol <br /> R a <br /> T Non-Hazardous waste, liquid <br /> O 001 TT Ir f^ G <br /> R b <br /> 15 Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> Wear PPE t1a 11b <br /> Emergency Contact <br /> (510) 797-8511 <br /> Attn Kirk Hayward <br /> 16 GENERATOR S CERTIFICATION I certify the materials described above on ibis manifest are not subject to state or federal reguEations for reporting proper disposal of Hazardous Waste <br /> Pnntedrryped Name Signature # <br /> R " �r r .d �� 1i j� y^�_ �4x� 1 tJ l j / Month Day Y/e�a�r+y <br /> /f�� l�.r '' j Z.� ,,,,y ti'�r ..E � ,r d {..p {# 't:a i�'�,iTti P 07 '��0 <br /> S 17 Transporter Acknowledgement of Receipt of Materials <br /> P PnntedlTyped Name Signature f` <br /> R tee` M& Da Yea <br /> R t f !f .jA/ <br /> 18 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I <br /> i <br /> 6 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 />