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1.r3aneretor's US FPA ID No. 2.Page 1 3.Document Number <br /> NON-HAZARDOUS °t NH- .47 5 <br /> WASTE MANIFEST 1 <br /> f- <br /> 4.Generators Name and Mailing Address <br /> y7g (�� 't• <br /> -a to 9 -ter t er+� �•ti - , <br /> t <br /> Genamtor's Phone <br /> 8. US EPA ID Number 7.Transporter Phone <br /> s.Transporter Company Name „ <br /> r <br /> CLEARWATER ENVIRONMENTAL CAR000007013 (510)797-8511 <br /> a.Designated Facility Name and Silo Address <br /> 9. US EPA ID Number 10,Facility's Phwte <br /> ALVISO INDEPENDENT OIL <br /> 5002 ARCHER STREET <br /> G ALVISO>CA 95002 CAL000161743 510 797-8511 <br /> 4. <br /> 11.Waste Shipping Name and Description 12.Containers 13, Unit <br /> N 1"otaf Unit <br /> E No, wwof <br /> R <br /> A allon-Hazardous waste, liquid <br /> 0 001 — G <br /> b. <br /> LS-Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> Wear PPE " r e" Yi ''}'+; 11a 116. <br /> Emergency Contact <br /> (510)797-8511 1,42 ' �"; '" <br /> Attn: Kirk Hayward `3j. <br /> 16.GENERATOR'S CFRTIFICAT1ON: 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 /> PdntedMt ped Name Sfgnature <br /> R � Mbrth Day Year <br /> N `w , <br /> S 17.Transporter Acknowledgement of Receipt of MateAls <br /> P Primtedlfyped Name Signature <br /> R Abrrh Day Year <br /> +..� fi� "� t,J � =�^' "r"+.� <br /> _........ <br /> R <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 <br /> except as Hated in item 18. <br /> PdnkK Typed Name Signature <br /> Month Day You <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) PINK 4RANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />