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ub�c i ur Ui.Obn JUIIB Huber p.3 <br /> Non-hazardous eater Transport and Disposal Form „Number: 691? <br /> Generator Information <br /> Name: IWILBER ELLIS <br /> Address: 212 INDUSTRIAL STOCKTON <br /> Description of water: Non-Haz purge water UST Sites <br /> Nen-9azardoub warm wafer,nwiioring well purge Wltes andiar auger rinsatEjznk rinsate or above described waler.This water may <br /> contain diss&ved hydrocahnns_i earthly thmthu atywe named material s a liquid exempt from rcra per 40 rtr261 4!6)(10)and does <br /> not meet the criteria of h aTardous waste as described in 22 ecr wicie 1 f or any ocher applicable state iaw.Has been properly <br /> describer Classifwd Snd packaged and is in proper condition for transportation according to applicable regulations. <br /> _ 1 <br /> Generator�Authorized agent <br /> Print sign date <br /> Trm-isporter Infonnation: <br /> Company namc: American Valley Waste Oil r <br /> Truck id Driverc�1�L f--3 i .t. ,r ,� �-� :,-- 1 �, — —o--i <br /> --- Print sign date <br /> Total Gallons . _ <br /> Facility TnfL)rmation <br /> Riv;;rbank Oil Transfer Approval Number 900-012 � <br /> 5300 Claus Rd <br /> Rivt'ba;.& Ca 35367 <br /> CalU00 190816 <br /> Via Railcar# <br /> ( t: <br /> Rece_ved by: 1.` t T �—,� �.�t ftJ {� � r FL: S.' <br /> t <br /> Print Eall name and sign date <br /> f <br /> 4, <br /> ' i <br />