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TF NUMBER MWS-fl�(o <br /> NON-HAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR LN'FORAIATION <br /> NAME Quit Stan Mark= Inc <br /> ADDRESS PO Raz 5745 <br /> CITY STATE.ZIP Fr=monr CA 94337 PJ40 E d 510-657.850t) -- <br /> 1)*,f Y IT1 ROY r)-WA 14J1 LeCo4 'btb+G WELL M3L=)DFCOM WA'[-,3l , <br /> i <br /> 1 CUr1Fy ThA(TMA 1AA11 a)AL �4 A�.)f l ILY,OCrAwr FNLia[7L[7cA��(ao[��7<1 t tBll)O.1lr15 T1C1LA <br /> KVT UM TNEcxrnuttw o1 m&zAxnot's wAiTE AI DEVCRMM P(:_'CCR A.1<rx=l)))x AV r(1r"l R Avrl x Aa L <br /> STATE L" HAS aZ'2'-PRQPLY.LT Ebm="" CLA:3U-lW AND rA(XkC=j0M G LY VROWN 1 V 411 X r Aq FOA <br /> 7WUPOAT'AT"wC'CrhflLYGTD AFPUCA1LYR7iCULATf0Wt <br /> Itch Carlow !2 �[7 <br /> GENERATOR/ALTHORT7.ED AGENT SI ATURE& .lrE <br /> ' SITE INFORMATION <br /> Site Operzior Addre= Gal, <br /> Qu2k st2p vmno= 3695 Pturl Ave Sam dose. CA Zuo <br /> ' TOTAL GALLONS. <br /> TRANSPORTER INEMRIMATION <br /> NAIME IWM, Tac. <br /> ADDRESS 950 Arca Aveaue `- <br /> ' CITY,STATE.Z1P Mlhmt , CA 95435 PHONE x (408}947_9455 - <br /> TRLCK ID#' b!IL QQ l2/lll 1, <br /> (Typed or gnnud full nAme&stgrt =c) (Date) -- <br /> RECErV NG FACILITY - <br /> ' N4-%1E McKamck WTS/iw"t. Lac <br /> ADDRESS 565_33 HwZr SSW <br /> CITY,STATE ZLF McMmnck. CA 93251 PHONE <br /> ' <br /> APPROVAL - 4q�,-3k6- <br /> a Fs <br /> (Tyad 0{p-.tQd full name&NaLmatu=) {Dat±} <br /> TOTAL P 02 <br />