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n <br /> NON - HAZARDOUS WATER TRANSPORT.FORM Number <br /> GENERATOR INFORMATION <br /> Name: Southland Cop <br /> Address: 1399 Main S <br /> City, State, Zip: Manteca, Ca Phone#: <br /> DESCRIPTION OF WATER: TANK RINSATE <br /> NON-HAZARDOUS WASTE WATER P40N TOPING WELL PURGE WATER AND/OR AUGER"SATE,TANK RINSATE. <br /> THS WATER MAY CONTAIN DISSOLvED HYDROCARBONS.I c.EKnFY THAT THE BELOW NAMED MATERIAL IS A <br /> UWD EXEMPT FROM RCRA PER 40 CF 261.4(b)(10)AND DOES NOT MEET THE CRITERIA OF HAZARDOUS WASTE AS <br /> DESCRIBED IN 22 CCR ARTICLE 1 1 OR ANY OTHf:RAPPLICABLE STATE LAW,HAS BEEN PROPERLY DESCRIBED, <br /> CLASSIFIED AND PACKAGED AND IS IN PROPER CONUTiON FOR TRANSPORTATION ACCORDING TO APPLICABLE REGULATIONS. <br /> Generator/Authorised Agent So �-fl fJqnarure& Dat <br /> SITE INFORMATION <br /> STA# JOB # TANK# ADDRESS USG <br /> 1399 Main St <br /> 1 Manteca, Ca <br /> 2 <br /> 3 <br /> 4 <br /> TOTAL GALLONS: <br /> I <br /> TRANSPORTER INFORMATION: GROSS <br /> TARE <br /> Name: Allwaste plod NET <br /> Address: ' , — TOTAL GALLONS <br /> City, State, Zip: 4 Phone -- <br /> Truck ID #: y� Driver: - <br /> (� 7� ( yped or printed tuR name& signature) (Date) <br /> DISPOSAL FACILITY INFORMATION: Time Out: <br /> Time In: <br /> Name: Seaport Env ronmental Time Spent! <br /> Address: 675 Se2po Boulevard <br /> City, State, Zip: Redwood City, Ca 94063 Phone #: (41 S) 364 1024 <br /> Approval #:• 610-509 Received by. <br /> (Typed or printed full name&signature) (Date) <br />