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------------ <br /> (MC W04-2) TF NUMBER: MCCKK-rL-94M-2 � <br /> NON-HAZARDOUS WASTE DATA FORM <br /> GENERATOR INFORMATION <br /> NAME: MOBIL OIL CORPORATIONS, ATTN: EARTH _ <br /> ADDRESS: 3225 DALLOW RD., 1W120 _ <br /> CITY,STATE,ZIP: FAIRFAX, VA 22307 PHONE#: (703) 846-3000 <br /> DESCRIPTION OF WATERS PURGE WATM 004UATM DURING LW"()OR DEVELOPMENT OF MONWORING WELLS LOCATED AT VARIOUS <br /> SriTS. AUGER RMATE GENERATED DURWO THE INSTALLATION OR MOMM)RRNO WELLS AT VARIOUS SITES, <br /> THE WATER HAY COlR'AIN DISSOLVED HYDROCARRoNs. <br /> GENERATOR CERTW=THAT THIS WATER t ra y <br /> AS D `J1rr ESCRMED IS NON.HA�nous (Typed or printed full name&signature) (Date) <br /> SITE INFORMATION <br /> STA# JOB I ADDRESS GALS <br /> 1 M-04-343 40051-PW 500 E. GRANTLINE RD., TRACY, CA 327 <br /> 2 M-99-MTE 40093-PW 5 N. SAN MATEO DR., SAN MATEO, CA 226 <br /> 3 M4)4-246 40050-PW 1097 SO, MAIN ST., SALINAS. CA 254 <br /> 4 <br /> 5 M-04-FPA 40131-BW 1705 WOODSIDE RD., REDWOOD CITY, CA 788 <br /> 6 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> TOTAL GALLONS: <br /> /,,5 d <br /> TRANSPORTER INFORMATION <br /> NAME: BALCH PETROLEUM/INTEGRATED WASTESTREAM MANAGEMENT <br /> ADDRESS: 930 AMES AVENUE <br /> CITY,STATE,ZIP: MILPITAS, CA 95035 PHONE1. 408 94' 8955 <br /> _V��TRUCK M#: PETERBILT HURSCHEL WARD 3 <br /> (Typed or printed full name&signature) (Date) <br /> FACILITY INFORMATION <br /> v <br /> NAME:. MCKITTRICK WASTE DISPOSAL <br /> ADDRESS: 56533 HWY. 58 WEST <br /> CITY,STATE,ZIP: CA 93251 PHONE#• 805 762-7607 <br /> RELEASE#: 792-587 PS <br /> P6L� ,/) /// • (T Or printed fu name&signature / (Date)7___ <br />