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SEP 28 2004 9: 06AM DOIILOS ENVIRONMENTAL 9169900932 P. 1 <br /> ' 05/27/2883 90'21 7538574 PAGE 02 <br /> r <br /> NON-HAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR CUSTOMER <br /> Name' Lo' Name <br /> ' Address- 0 Address- p <br /> Z <br /> Phone 3 Phone <br /> ' DESCRIPTION <br /> Descnpuon of water 1 <br /> Volume/Weight: 44-0G2 . —Units Container(s)- <br /> C/ <br /> This nnn-hazardous wase water is momoring well purge water,auger rnnsate,samp1mg equipment Ansate,lank <br /> nnsate,combination thereor,or as described above Described water may contain ditsolved hydrocarbons I certify <br /> that the above named matenal has been properly described and 018221 f ed eecording to applicable regulations,and <br /> possesses no characteristics that would require its handling as a hazardous waste. <br /> ' Generator/Authorized Agent. P _,,IZ � q-3 -02 <br /> Print Sign Dace <br /> TRANSPORTER <br /> , <br /> Name, Job No; C.44�. � �--¢� <br /> Address: -40 �Z..S�S'�-� Pick-up Date, 9-,j <br /> G Truck ID. <br /> ' Phone- Driver' 4.61 <br /> 1 ` <br /> ` Sign Date <br /> IDISPOSAL FACZLIT'Y <br /> Nagle: <br /> i4�-- Quantity <br /> Address Units. <br /> Disposal Method <br /> Received by g <br /> Print Date <br /> 1 <br /> U3/04/2004 21'20 530753182 INSMT IWC PAGE 132 <br />