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uuuz <br /> N11 14:91 FAX 510 Ear 0621 EBat1D 3O1.7tCE CTL <br /> TRUCKEQ-NON-HAZARDOUS WF„TE <br /> �ISMUO DISPOSAL PERMIT Terms and Conditions <br /> Liquid Waste Acceptance Agreement <br /> i) permit Holder. Copperford,LLC <br /> 7) perrnit Number:2241 <br /> 3) Discharge Number:2241 A <br /> 4) Source or Mawrial to discharge: <br /> Addtcsa Mattrial Composition S'istitrv�ttd Volume <br /> Co,ryaay Name (gallon+lrneacured wil <br /> 11x70 Locke Hoed,61dg. 100 WU' wasro <br /> Cop�alotd,LLC Lakcford,CA 95237 vera B IY..vrnc ices <br /> 5) Transporter Information <br /> 7ransyona Company Nemc aad T..rck Dcscrip <br /> ti— Trek Truck I.D. Tractor I.D. Tank <br /> Pb..4ambcr Licerua Nwnhm Natt C.; <br /> s/bans) <br /> Number <br /> Chemkcc FRighs tw SK Anecb...c.+t <br /> 7091911.7570 <br /> Jack <br /> 6) Describe)known and potential Pollutants in this—rite <br /> Wine Lecs,KMBS,Bentonite <br /> 7) Fc"for Discharge of Trucked Waste <br /> Copperford, LLC shall pay�/.CAIil11/ alioalLo for hauled truck waste dischargod Io the <br /> E13MUD W WTP. The fees billed for the di.chargc will he calculated bwcd upon the <br /> full volume of lite transport vehicle. The District will bill wabtc trampotters monthly. <br /> Permit Hal r s Signature <br /> Date <br /> S at <br /> i <br />