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Mar-23-00 00: 10 650 364102016 <br /> P _02 <br /> *tie.1A 4 <br /> �^ �f <br /> s <br /> a <br /> It a, <br /> Seaport Environmental �« <br /> NON-HAZARDOUS WATER TRANSPORT FORM'- <br /> GENERATOR <br /> ORM``GENERATOR INFORMATION CUSTOMERRI1F0WON <br /> Quik Stop Market# 121 IWU <br /> 7}fi <br /> 1196 E Louis Ave <br /> Manteca Ca V*` <br /> PQ# <br /> DESCRIPTION OF WATER Pump Tost g <br /> NUN-HAZARDOUS WASTE WATER MONITORING WELL PURGE WATER AND/OR AUGER HINSATE TANK' ATE OR ABOVE <br /> DESCRIBED WATER THIS WATER MAY CONTAIN DISSOLVED HYDROCARBONS I CERTIFY THAT THE ABOVE NAMED MATERIAL <br /> 15 A LIQUID EXEMPT FROM RCRA PER 40 CFR 261 4(b)(10)AND DOES NOT MEET THE CRITERIA OF HAZAFiUVUS WASTE AS <br /> DESCRIBED IN 22 CCR ARTICLE 11 OR ANY OTHER APPLICABLE STATE LAW, NAS BEEN PROP-E�Y DAAMWiED. <br /> CLASSIFIED AND PACKAGED AND IS IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TO ak <br /> REGULATIONS <br /> s <br /> _gyp r4 <br /> f r• JJ/J <br /> G neral Authors sign date <br /> SITE INFORMATION <br /> 1 196 E Louis Ave GROSS } <br /> Manteca TARE <br /> Ca <br /> NET <br /> TOTAL GALLONS �no <br /> � <br /> MICUISEN ai U MJDt Per U5G <br /> I <br /> TRANSPORTER INFORMATION <br /> Truck ID <br /> IWU <br /> Driver �/e TCS h� � Lle=� _ <br /> f� r `L, <br /> yid t� <br /> Print full a rS gn v c_ <br /> r ° <br /> TIME OUT Lq <br /> a <br /> TIME IN <br /> TIME SPENT t� <br /> z <br /> DISPOSAL.FACILITY INFORMATION EPA ID CAL 000032058 <br /> a , <br /> x <br /> Seaport Environmental Approval Number Solids%Wt , <br /> 675 Seaport Boulevard ' <br /> Redwood City, Ca 94063 302 053 <br /> Phone (650)364 1024 *s <br /> Solids Surcharge <br /> - - 01USG 1 �„ <br /> Received by , <br /> Print full name d,sign a e ,- <br /> x <br /> �xY <br />