Laserfiche WebLink
LAD WASTE MANAGEMENT, I�. 42516 <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 /> i Well# <br /> Ph# U 7� <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: iy Soil ❑ Brine ❑ Drilling Mud ❑ Other <br /> ' B. Licensed Waste Hauler / <br /> Company / J •7� <br /> Address _ <br /> ' Truck# <br /> C. Delivery Date: D. Invoice: Hauler <br /> ' f <br /> Dale: " 01 / � /? <br /> / X Waste Source <br /> Quantity� 5—' Tons Wash Out @ $ ea. <br /> bbtr- <br /> Cost Per Ton Total Cost <br /> ' 'I certify that the above described waste was hauled to this approved os sit and was an acceptable <br /> waste as established by Order No. -72-256 of the California Re ' n W r al" Control Board.' <br /> ' Signature of Disposal Site Operator HAULER t e of Licensed Hauler <br /> 1 ' <br /> 1 <br /> i <br />