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Generator Information 8959652 <br /> Name Flame Liquor <br /> Address 1301 West Kettleman lane Lodi <br /> Description of water Non-Haz purge water UST Sites <br /> Basis for detemunation that water is non haz Analytical <br /> Generator/Authorized agent <br /> Print sign date <br /> Transporter Information <br /> Company name- American Valley Waste Oil <br /> Truck Id _Driver !�. i�.C, r� �'.�a—=Ti <br /> Print sign <br /> Total Gallons ,3 pr_-4-) <br /> Facility Information <br /> Cascade General Luc Approval Number 800.030 <br /> 5555 N. Channel <br /> Portland, OR 97217 <br /> ORD18761934 <br /> Via Railcar 4 � <br /> Received byC je4K <br /> Printfull name and sign d <br /> • <br />