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mot im M �► <br /> t <br /> 48882 <br /> �VOWHAZARbOU$,Waste Hauler Document Dally Field Ticket No <br /> 6ENERATOR.4 ' DESIGNATED TSD FACkITY ALTERNATE TDS FACILITY <br /> Name <br /> " C ame Name <br /> EPA# k EPA# EPA# <br /> Address Address Address <br /> J ` e <br /> Order Placed _ Order Date <br /> 44ASTE ❑ - DRILLING MUD ❑ - GASWELL WATER - OTHER <br /> )KTF1- <br /> Welght/volume Units Container ❑ - Dump Truck Tank Truck <br /> I8 gral Is nonhazardous because <br /> if Is d drilling mud cantarmng oNly the additives listed by the Department In its exemption <br /> ,tafite at4,acimams no sign ificantconcentrations of toxic materials from naturat sources or <br /> Vis a sulfur-dioxide scrubber solution from a sodium hydromse or sodium carbonate oil DATE <br /> tiotl� we <br /> ller scrubber system and pbssess no Characteristics that would require its <br /> SIGNATURE OF AUTHORIZED AGENT <br /> handling as a hazardous waste ' <br /> . i <br /> TRANSPORTER <br /> Warren E Gomes Exc , Inc' ,fob No Pi k Up ate <br /> P 0 Box 389 ' <br /> Rio Vista, CA 94571 Wrilt NO JAZW <br /> VGNATURE OF BUYER <br /> (747) 374-2881 # <br /> EPA # CAD478557378 , 4 <br /> a Method of Disposal: <br /> TSD FACILITY <br /> a - Injection Well <br /> Name - OT1Y Measured eCZ 0 - Landfill <br /> o - Land Treatment <br /> r � <br /> EPA# 0 - DBL ❑ - TONS )7 - OTHER ❑ - Surface Impoundment <br /> a - Other C-_ <br /> I { <br /> SIGNATURE OF AUTHORI ED A ENT DATE <br /> r � i <br /> l TSDF TO GENERATOR <br /> j <br />