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NON-HAZARDOUS Waste HaEuler Document Dally Field Ticket No 48581 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Namei,� 1� Name--T�,,�,,�-R��T ----- — ---- --Name �u ----- _- - --_ -_�-- --- <br /> EPA# EPA# EPA# <br /> Address Address �0 I i dress <br /> Order Placed _ Order Date <br /> "STE ❑ - DRILLING MUD O - GASWELL WATER OTHER��_ <br /> Weight/Volume 4*5 Units 22APS Container ❑ - Dump Truck R - Tank Truck <br /> This material Is nonhazardous because <br /> 1)it is a drilling mud containing only the additives listed by the Department In Its exemption <br /> let(6r and Contains no significant concentrations of toxic materials from natural sources or <br /> 2)is a sulfur-dioxide scrubber solution from a sodium hydroxise or sodium carbonate 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 <br /> TRANSPORTER <br /> Warren E Gomes Exc , Inc Job No Al_�► VM e I`ic - Dae <br /> P O Box 369 <br /> Rio Vista, CA 94571 Unit No !1C_"�t <br /> (707) 374-2881 T <br /> SIGNATURE OF BUYER <br /> EPA # CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Infection Well <br /> Name QTY Measured 2. 7 3 in � o - Landfill <br /> o - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS ❑ - OTHER o - Surface Impoundment <br /> 9�Other 4 <br /> _/ , <br /> r <br /> sem. fa '. Z. o L '� <br /> SIGNATURE OF AUTHORIZED AGENT ATE <br /> TSDF TO GENERATOR <br />