Laserfiche WebLink
�40WHAZARDOUS Waste Hauler Document Dally Field Ticket No �� �L� 4 8 15, 19 <br /> 0 <br /> D <br /> GENERATOR. DE IGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Na e _MQ► Name <br /> EPA # ER1# EPA # <br /> Ads�rAbJ - Ad ress -{�- Address <br /> C 1 <br /> r <br /> Order Placed _ Order Date <br /> ti I <br /> WASTE ❑ - DRILLING MUD 13r- �"aASWELL WATER J - OTHER <br /> Weight/Volume—62rD Units _ Container ❑ - Dump Truck Tank Truck <br /> TNIs material Is nonhazardousbecausgL <br /> R;is a drilling mud containing only tFeiiii additives tested by the Department In its exemption <br /> Zer and contains no significant concintrations of toxic materials from naturil sources or <br /> $a Sulfur-dioxide scruboetr kolvl3oiz`IMm a sodium hydroxlse or sodium garbonate oil <br /> field boiler scrubber system and pooesses no characteristics that would require Its SIGNATURE OF AUTHORIZED AGENT DAT <br /> handling as a hazardous waste <br /> TRANSPORTER <br /> Warren E Games £xc , Inc ' Job No'-,"z-,-T� ���� � c - p-Date X <br /> /.1'2r) <br /> P 0 Box 369 ' <br /> Fico Vista, CA 94571 , lnit No <br /> (707) 374-2881 ,; <br /> NATURE OF BUYER <br /> EPA# CAD076557370' - <br /> F <br /> { <br /> r TSD FACILITY Method of Disposal: <br /> `f a - Injection Well <br /> Name QTY Measured 0 - Landfill <br /> ,--_ - ------- -�----- -- -- ------=---- - - _—_ - - - - -- ---- n - land Treatmept_--- - -- - - -- - <br /> EPA# O -'BBL ❑ - TONS Q - OTHER o - Surface Imu�d�rtent <br /> o - Other- <br /> SIGNATURE <br /> / a <br /> SIGNATURE OF AUTHORIZED ENT DATE <br /> 0 ti <br /> TSDF TO GENERATOR <br />