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.3-24—I``iJ�J 10:12AM FROM SEAPORT 166036d1021 <br />T ,,vv <br />NON-E4AZARGOUS WATE fT&S�T FQR4 <br />r . <br />GENERATOR INFORMATION <br />Sanactlnc <br />3480 E. Carpenter Rd. <br />Stootcrt Ca <br />P. 1 <br />CUSTOMER INFORMATION <br />Alvanced CleMWTechnD" Inc <br />Pp # <br />DESCRIPTION OF WATER: Undergound Tar* Removal <br />NON-IJAZARWJS WASTE WATER, MONITORUIS. WELL.pURGE WATER ANQ/OR AL'GER RINSATE, TANK MSATE OR AMtVE <br />DESCRIBED WATER. THIS WATER MAY CONTAIN 91SSOLVED HYDROCARBONS. I CERTIFY THAT THE ABOVE NAMES MATERIAL <br />ISA LIQUID EJ(U C R ARTICLE <br />iPER 4D CFR THEA (trntWAND DOE$ NOT MMT THE CRITERIA OF-F�pRDOUS WASTE AS <br />DESCRIBED IN D CCR ARTICLE 1 OR gryy OTHER APPLICABLE STATE LAW. HAS BEEN PROPERLY DESCRIBED, <br />CLASS1 TiO AND -PACKAGED AN' <br />IS IN PROPER CONDITION FOR TRANSPORTATION ACCOROING TO APPLICABLE <br />REGULATfONS. <br />van-cra,011AUthonsed_ Agent <br />S'q�✓ date <br />SITE INFORMATION <br />348P E Carpenter Rd. <br />Stockton <br />Ca <br />TRAMSPORTER tNFa tAT.ION <br />ACTT <br />361 � �yW�1Nf � <br />S15-1 D <br />DISPOSAL FACILITY INFORMATN?N <br />Seaport Environmental <br />675 Seaport Boulevard <br />Redwood CitK, Ca 84063 <br />Phone! (650) 364 1024 <br />Received by: <br />Print rub' name & yign <br />GROSS <br />TARE <br />NET <br />TOTAL GALLONS O.-... <br />� NkJSLN it It,3�1p5 OEf Uf4 <br />TruCk� ID: <br />Drive�2JJLLP,_ -- j Z <br />Print full name <br />h signn � .17 <br />TIME OU7 - <br />TIME IN <br />T" SPENT <br />Approval Number <br />3B7 - S54 <br />Solids %nit PH <br />Solids Surcharge <br />C/USG <br />2!y�%/ <br />date <br />i <br />