Laserfiche WebLink
' LIQUID WASTE MANAGEMENT, INC. 42491 <br /> STAR RTE. BOX 4, CORNER HWY. 33 AND HWY. 58 <br /> MCKITTRICK, CA 93251 <br /> ' (805) 762-7366 Approval# <br /> ' Lease Scale Ticket # <br /> Well# <br /> Ph# <br /> Approved Disposal Site Operator <br /> ' McKITTRICK LIQUID WASTE MANAGEMENT, INC. <br /> LIQUID WASTE DISCHARGE REPORT <br /> A. Liquid Waste Source: <br /> ' Company <br /> ' Address <br /> Description: --�] Soil ❑ Brine ❑ Drilling Mud ❑ Other <br /> B. Licensed Waste Hauler <br /> Company <br /> Address <br /> Truck# /2 <br /> C. Delivery ate: D. Invoice: Hauler <br /> Data: '�J/ / Waste Source <br /> Quantity "� `� / To5 Wash Out: @ $ ea. <br /> Cost Per Ton Total Cost <br /> ' 'I certify that the above describ d waste was hauled to this approved disposal site d asan acceptable <br /> aste as establis ed by O der No. 72-256 of the California Regional Wate uality _ and <br /> G <br /> Signature of Disposal Site Operator HAULER Sig ature of Licensed Hauler <br />