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d fi <br /> a ' <br /> I4�N-HAZARDOUS Waste Hauler Document Dally Field Ticket No 46,407 49546 <br /> E <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name Namly Name <br /> € P <br /> 4 � i <br /> EA# EPA 1# EPA# <br /> Address Address s� t tz a Y rt f4 Address <br /> 4 <br /> r <br /> Order Placed Order Date <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER - OTHER A, <br /> 1 - 1 Weight/Volume ( �_n- - Units Container ❑ - Dump Truck Z - Tank Truck <br /> This material is nonhazardous because <br /> 1)itis a drilling mud containing only thB a4ttlYes listed by the Department on its exemption <br /> letter and contains no significant concentrations oll toxic materials from natural sources or <br /> 2) is a sulfur-dioxide scrubber solution from a sodst�m hydroxlse or sodium carbonate oil <br /> field bolter scrubber system and possesses no cctenstics that would require its SIGNATURE OF AUTHORIZED AGENT DATE <br /> handling as a hazardous waste <br /> : t <br /> TOANSPORTER =` ,, , <br /> Warren E Gomes Exc , Inc Jqb Not~ � �M-T�-1 I Oft, Pick Up D `e <br /> O Box 369 <br /> io Vista, CA 94571 Unit No ila <br /> (707) 374-2881 SIGNATURE OF BUYER <br /> EPA # CAD076557370 � <br /> � 5 <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Infection Well <br /> Name OTYa`Measured �' � ` ❑ - Landfill <br /> / ❑ - Land Treatment <br /> EPA# f; ❑ - QBL ❑ - TONS --❑ - OTHER ❑ - Surface Imp t indTnt <br /> ❑ - Other <br /> SIGNATURE OF AUTHORIZED AGENT 3 DATE <br /> t a <br /> r J <br /> 't TSDF TO GENERATOR` <br />