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Seaport Environmental <br /> NON-HAZARDOUS WATER TRANSPORT FORM <br /> CUSTOMER INFORMATION <br /> GENERATOR INFORMATION American Valley Waste Oil <br /> Advanced Geo Environmental 209-667-8857 <br /> Variuos Sites <br /> PO# <br /> Various Ca <br /> DESCRIPTION OF WATER: Monitoring Well Sampling <br /> NON-HAZARDOUS WASTE WATER,MONITORING WELL PURGE WATER AND/OR AUGER RINSATE,TANK RINSATE OR ABOVE <br /> S A L QUED EXEMPT FROM RC PER 0 C RA26 .4IN (�10�1D DOELVED S NOT MEET HE C CERTIFY <br /> OTHAT FiHAZARDOUS WASTE ABOVE NAMED MATERIAL <br /> DESCRIBED IN 22 CCR ARTICLE 11 OR ANY OTHER APPLICABLE STATE LAW,HAS BEEN PROPERLY DESCRIBED, <br /> CLASSIFIED AND PACKAGED AND IS IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TO APPLICABLE <br /> REGULATIONS. ' <br /> Sign date <br /> 6anaratorllWthofiiad Agent <br /> SITE INFORMATION E01 <br /> VariUOS Sites <br /> Various <br /> Ca <br /> QC7 <br /> I <br /> I <br /> TRANSPORTER INFORMATION <br /> Truck 10,: Lia <br /> American Valley Waste Oil <br /> Driver. n date <br /> Print full name sign <br /> TIME OUT <br /> TIME IN <br /> TIME SPENT <br /> DISPOSAL FACILITY INFORMATION EPA ID:CAL 000032050 <br /> Seaport Environmental Siouleviird <br /> Approval Number Solids%Wt PH <br /> 575 Seaport Boulevard 500 713 U <br /> Redwood City,Ca 94053 L'J <br /> Phone: (550)364 1024 <br /> Solids Surcharge <br /> ¢LUSO <br /> Received by data <br /> Print full name 8 a gn <br />