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' - LIQUID WASTE MANAGEMENT, 1C. 42476 <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 -/ y <br /> Company /l <br /> Address' /--7 Truck / <br /> C. Delivery Date: n D. Invoice:- Hauler <br /> Date: J — X Waste Source <br /> Quantity /7 ��— Tons Wash Out: . @@$$ — ea. <br /> Cost Per Ton Total Cost . <br /> 'I certify that the above descd d waste was hauled to this approved disposal site and was an acceptable <br /> waste as established by rder`flo. 72-256 of the California Regional Water Quality Control Board' <br /> ' Signature of Disposal Site Operator HAULER Signat re of Licena Hauler <br /> f� <br /> rFNi <br /> W�. <br /> i <br /> 6 fi;r' <br />