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s <br /> NONT-HA.ZARDOUS VVATER.TR.ANSPORT FORM <br /> Q/ <br /> GENTERATQR <br /> CUSTOMER <br /> - <br /> T C <br /> Name: Lf[ �1 L� + -{ ?dame: h6 fl(ZO� <br /> Address: U Z- P <br /> N Address:�[� <br /> f' Phone: Da 11-1.5 <br /> Phone: <br /> DESCRIPTION <br /> De,scriptfcn of water: Mcllito,in- well Lr&e water <br /> %7 oluz=;e: Units: L Container(s):_- yo <br /> This non-:hazardous waste Water is rxm0nitori,-19 well purge wat--r, auger 7insate, senviing equipment rinsate,tank- f <br /> rinsate, combination :1iereof, oras described above. Described water may contain dissolved hydrocarbons. 1 certi& <br /> that the above named Material has been prorerly described and classified accordirtg to applicable regulativas, and <br /> Possesses no characteristics that;volld require its handling as a h37.drdOJ5 WaStc.' <br /> Generator/ <br /> Authorized Agent: Prig.. Sign Date. <br /> TRANSPORTER <br /> Name: Job No: °Ly <br /> E Address: 1-tg7� w'OPpL� Pick-up"Date: _ <br /> _Truck ID: : . . <br /> C <br /> Phone: aG�� ,�-2�,7Lt' Driver: <br /> n' Date <br /> i <br /> DISPOSAL FACILITY <br /> Name: _ int �at In <br /> Address: i l OSC AiroortLYa� <br /> .Ejo Vista CA_ - Dis.pos M d: GAC <br /> Received 1by: r 1L <br /> Print � S <br /> :g, Date <br />