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r„ R"�• _i^;��..-.ire .. .:: �_� _ .r _ -- _ _- ,�P r- <br /> T� <br /> l <br /> I Generator's US EPA ID No 2 Page 1 3 Document Number <br /> NON-HAZARDOUS of NH-- 4 9 4 3 9 <br /> WASTE MANIFEST 1 <br /> -� <br /> V4 Generator's Name and Mailing Address <br /> .�- <br /> Generator's Phone �,'�,^ � r� �- --� `�!�✓'r <br /> 6US EPA ID Number 7 Transporter Phone <br /> 5 Transporter Company Name <br /> CLEARWATER ENVIRONMENTAL CAR000007013 (510) 797-8511 <br /> 8 Designated Facility Name and Site Address 9 US EPA ID Number 10 Facil$ty's Phone <br /> ALVISO INDEPENDENT OIL <br /> 5002 ARCHER STREET CAL000161743 510) 797-8511 <br /> G ALVISO, CA 95002 12 Containers 13 <br /> tat Und <br /> it <br /> E 11 Waste Shipping Name and Description WI/VolN No r]uanu <br /> E <br /> R a <br /> A Non-Hazardot,�waste, liquid 001 TT ! O <br /> T , <br /> 0 <br /> R b <br /> Handling Codes for Wastes Listed Above <br /> 15 special Handling Instructions and Additional Information 11a 11b <br /> Wear PPE <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 /> PnntedtTyped Name <br /> Month Day Year <br /> A � <br /> S 17 Transporter Acknowledgement of Receipt of Materials <br /> P Signature <br /> O Pnnted/Typed Name j'' Mon fh Day Year <br /> P 4 <br /> P-^ r <br /> R _ <br /> R ' <br /> 18 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> T <br /> YOr Op Certification of receipt of waste materials covered by this manifest except as noted in item 18 <br /> 19 Facility owner or <br />± _ Signature <br /> Prjntedfryped Name Month Day Year <br /> t PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br /> YELLOW—GW (Retain Copy) — <br />