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14ON-HAZARDOUS Waste Hauer Document Daily Field Ticket No �A7�-�.__ 48536 <br /> k <br /> G <br /> � <br /> GENERATOR " DESI,GNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name Name'' 570�1 I Name <br /> EPA # EPA EPA# <br /> t <br /> AffidrlLa, 211' .,, AddressI S' Address <br /> R !_ <br /> Order Placed Order Date <br /> NtASfe, ❑----DR#LLINfi MUD - -❑ - GASWELL WATER ® - OTHER ,..,_.._.....—.-- <br /> ,c Weight/Volume Units Container ❑ - Dump-Truck ®-- Tank Truck a <br /> r Tfras�lenef is nonhazardous because <br /> t14' rdllp9 mud containing only,lho�ddltives listed by the Department in its exemption <br /> 18th cdntalns no slgnificat conceaYratlons of toxic materials from natural sources or <br /> 2}is a sulfur-dioxide scrubber aotutlon from z sodium hydroxise or sodium carponate oil <br /> field boiler scrubber system and possesses�no characteristics that would require its SIGNATURE OF AUTHORIZED AGENT DATE <br /> handling as a hazardous waste a <br /> TRANSPORTER r <br /> Warren E Gomes Exo, Inc. s Jqb No Pick-Up c k2 t04 <br /> _ <br /> R O Box 369 ' I <br /> Rio Vista, CA 94571 U it No <br /> : <br /> (f 07) 374-2881 w � <br /> SIGNATURE OF BUYER <br /> EPA #CAD076557370 <br /> TSD FACILITY _ Method sof Disposal: <br /> - ❑ - Injection Well <br /> game —... -� QTY Measured � - 0 - Landfill <br /> -- - - - - - - -- - -- - - - ---- - --- - --- _ -- -- -- - -- --- Q-_Land-Treat t - -- - ---- - - - - <br /> EPA # :,._ „ ..,.... ❑ - 138L ❑ - TONS ❑ - OTHER fl - Surface Inindment <br /> {f L1="Other <br /> 1. <br /> SIGNATUrF Of AUTHORIZED AGENT IYATE <br /> TSDF TO GENERATOR <br />