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Apr-16-02 21 :22 Seaport r 0'1_,' ilieum 660 3641023 P.01 <br />' Seaport Environmental <br /> NON-HAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR INFORMATION CUSTOMER INFORMATION <br /> I L►(ii Theatre Ameriiwn Valley Waste Oil <br /> 107 N School St <br />' Lodi Ca AO# <br />' DF,SICRIPTION OF WATER Mc)nitonnrg Well Sampling <br /> NON HAZARDOW;WAyTE WATER MONITONIN(,WELL PUR(;E WATER AN01OR ALIGCR HINSATE TANK RINSATE Olt AHOVE <br /> DESCRIDEr)WATER T€III,WATER MAY('U€VTAIN OISSOI VED HYOR()C.AR50NS I CFRTIFY THAI rHE AC3OVC NAMFr)h€ATr_RiAL <br /> I`,A I IOUID EXCMP r FROM RCRA PER 40 Cf R',2E>t 4(b)(10)AND I)UES NOT MEI-T THE CRITI-RIA OF HAZA1tl)0tJS WASTE A, <br /> DESCMBLI)IN 22 CCT,ANTI( LE 11 OR ANY OTHER APPLICABLE STATE LAW HAS ©FEN PROPERLY I)Fti(RILtED <br />' ('LAti'�IFIED AND PA( KAa,ED ANL)I`,IN PROPER CONIPTION FOR 1 RAN5PORTA7ION ACCOROtM. r(1 APPLICAC3LL <br /> REGULAI IONS <br /> f C j1�/�✓ <br /> G rrainrlA{r1110rr3rd gent <br /> Sign dale <br />' SITE INFORMATION <br /> 107 N SUloot St (,ROSSG� <br /> Lodi (AHE <br /> NET <br /> TOTAL UALLrONS <br />'• TRANSPORTER INFORMATION <br /> Trudc IO At <br /> Amencin Valley Wa51e Oil <br /> Print full name&sign date <br /> TIME OUT <br /> TIME IN <br /> TIML SPENT <br /> DISPOSAL FACILITY INFORMATION EPA ID CAL 00003WSS <br /> Seaport Environmental Approval Number Solids%Wt pH <br /> 975 Seaport Boulevard <br /> Redwood City,Ca 94o63 3t]2 � 95s <br /> Phone (650)364 1024 <br /> Solids Surcharge <br /> 41U5G <br /> Received by <br /> Print rule naive&sign dale <br /> I <br />