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–La--t��a :a,rr7 r rcurl P_ 2 <br /> MON - HAZARDOUS ATE SPOT FOR t <br /> GENERATOR INFORMATION <br /> Name. CAL TEXACO <br /> Address. MOSSDALE R®. <br /> City, State, Zip: STOCKTON.CAL PhoneV 209.983-9029 <br /> DESCRIPTION OF WATW. RAW WATER IN YAW <br /> WWMZARDOUS WASTE WATM MONTORM WELL FURS WA71R AWOR AWIt NWATE.TAW RINSATE. <br /> THIS WATER MAY CONTAIN DISSOLVED HYOROCARSONL I CIRVY TMY 'Is A <br /> LIWD EXEMPT FROM RCRA PER 40 CER 261.4 WO O)AND DOES NOT MEET TI+F CRT074A OF IIAZARIOUS WANN AS <br /> DESCRIBED eN 22 CCR ARTICLE t 109 ANr OTHEWPLICABLE STATE LAW,M2 961N PROftALY DE <br /> CLASSIFIED AND PACKAGED AND IS IN PROPER CONDITION FOR TRAN94MATom ACCONOINa TO A^PPU RE TIONS. <br /> fa�Ll�I I►t �c iC t-+®l IJ 1Q / 7 1 Cwt /- -� - <br /> Generator/Authorised Agent Signature&Date <br /> SITE INFORMATION <br /> SITE JOB# TANK 0 ADDRESS USC <br /> moSSDALE RD. <br /> t f-518* 1jQVW—*f'1—S-T0CKTON,CAL, of <br /> 2 <br /> 3 <br /> 4 <br /> TOTAL G y <br /> TRANSPORTER INFORMATION: GWR—OSS <br /> TARE <br /> Name: Af Ste (CPC HFAT FX ERS) <br /> Address: 395 West Chamel Road TOTAL GALLONS <br /> City, State, Zip: Neniaia,Ce 94S 10-1117 Ph (707Y746 8287 <br /> Truck ID 0: 1 '} q Driver. <br /> (Typal or ofted full narne 6 t ) (One) <br /> DISPOSAL FACONY INFO T <br /> imet® <br /> :Narne: SeaEnvironmental Spent: <br /> Address: 675 Seaport Boulevard <br /> City, .State.Zip® Redwood City. Ca 94063 Ph (415} 3 <br /> Approval 101-588 Received b : I L <br /> er print m®&1 turej .(Date) <br />