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04/06/2004 0B:03 2094671118 AGE STOCKTON PAGE 05/0 ' <br /> Jury-10-01 20:46 Salm Prat,relaum 660 iQ21 P.02 <br /> Seaport Environmental <br /> NON-HAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR INFORMATION CUITUMER INFORMATION <br /> Mol Bakides Amerloan Valley WaSle Oil <br /> 4&S+kftr&Vd ?a i W— A-&I '4"f- <br /> MameaL- ce heli Cp - PO# <br /> DG5CRIPTION OF WATER; M011110flr1$Well SaVIng <br /> NON-HAZARDOuS WASTE WATER,MONITORIK WF.I.L Pk)RQE WATEND10R AUGER RINSATE,TAMS HINSATE OR ABOVE <br /> DESCRL A L UIUIU KLMI H I f THIS <br /> I tV V1 F t4111 aVONTAIN 3tiD4(b)(10)AN3 DORI DLYED OT MOOT r,41�CRITRWIA 016 tE1A2A ABOVE <br /> WASTE A9µIAt ;I <br /> DESCFtl!!FI)IN 22 OCA ARTICLE 1 i OR ANY 07HER APPI.10ABLE STATE LAW,HAS PEEN PROrERLY DE6CHING0, <br /> CLASSIFIED AND rACKAGE1 ANI]19 IN PROPER CONDITION FOR TRANSPOKrATION ACOORDING TO APPLIWLE <br /> FSF[:4i{a r it�NR, � <br /> GanerAtOrrAalharlsaF!Agent sign dotf y <br /> f <br /> SITE INFORMATION <br /> 983 Moffett Blvd GRAB p <br /> r <br /> Mir llut,er TARC <br /> ca NET <br /> TOTAL 0ALLONS { <br /> • C'IkulrrNtl HF Fr,}olfl p�. ' <br /> TRANSPORTER INFORMATION <br /> American V1111ey waste Oil TrucE; <br /> DriYRr: <br /> e- <br /> Print full name, Mon dau <br /> TIAAS our <br /> TIME IN <br /> TIME SPENT � <br /> DISPOGAL FACILMY INFORMATIOr4 EPA I0,CAL 0000320JS8 <br /> S i <br /> Seaport Environmental Approval Number Balls%wt Pel• <br /> 875 000 rt BoCa 944 3Q2 <br /> Roervpa�crty,Ca 9ans3 <br /> Ptlona:(850}384 1024 <br /> Salida Surpnar✓ga j <br /> R$661vea by: <br /> Print Full name d s an <br /> I <br /> d <br /> i <br />