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Generator Inforroation 8958653 <br /> Nanne Flame Liquor <br /> Address 13 01 West Kettleman lane Lodi <br /> Descnption of water Non-Haz purge water UST Sites <br /> Basis for determination that water is non hax Analytical <br /> Generator/Authorized agent r— c <br /> Prirtt sign to <br /> Transporter Informatton; <br /> Company name American Valley Waste Oil <br /> Truck Id —Driver <br /> Print SfIV date <br /> Total Gallons 706 <br /> Facility Information <br /> Cascade General Inc Approval Number 800-030 <br /> 5555 N. Channel <br /> Portland, OR 97217 <br /> ORD18761934 <br /> Via Railcar# ;� / �' /� <br /> Received by: lC/`�' -- CD <br /> Flint full name and sign date <br /> i <br />