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1- <br /> ..s <br /> NON - HAZARDOUS WATER TRANSPORT FORM iber p p <br /> GENERATOR INFORMATION <br /> Narne: CAL TFYACO <br /> Address: MOSSOALE RD. <br /> City, State, Zip: STOCKTON, a a: 209.993-9028 <br /> DESCRIPTION OF WA7W, FLOOD WATER IN TAW <br /> NON4iAWDOUS WASTE WATM MONTOWA WUL PURGE WATR ANYOR AUGER RWATL TANK RINSATF. <br /> THM WATER MAY CONTAIN nissMYED HMOCMOW&f CFRM THAT THE 98.0w KAM MATERIAL Is A <br /> UQM EXEMPT FROM RCRA PEre 40 CFR 261.4(b)(1 O)ANO DOES NOT MEET TW CRnINA OF KAZARDOUS WASTIE AS <br /> DEScRIBEo cN 22 CCR ARTICLE 1 i OR ANY OTKRAPFUQABLE STATE LAW,K45 MEN PROPERLY DESMSED, <br /> CLAsSIFIEd AND PACKAGED AND IS IM PROPER COMTIOH FOR TRAMSPORTATION ACCORDING TO APKWASU RE <br /> Ge,zer;►CorlAuised Agent Si twe a Date <br /> SITE INFORMATION <br /> SITE JOB IN TANK# ADDRESS usG <br /> MOSSDA , <br /> 1 •3l �Suc. T ____ L. <br /> 2 <br /> 3 <br /> 4 <br /> TOTAL GAMONS: <br /> TRANSPORTER INFORMATION: GROSS <br /> TARE <br /> Name: Al St0 LCPC HFAT EX ERS) NET <br /> Address. 395 Wost Chantal Road TOTAL 3ALLOf•lS <br /> City, State, zip: aerdoa,C&94S 10-1111? Phone 0. (07) 746 8287 <br /> Truck ID : Err: e&W1-f0q5 <br /> (Typed or printed fug ftme i sK tW@) (Oats) <br /> 11,mmwl <br /> DISPOSAL FACILITY INFORMATIOPL° Time Out: <br /> Time In: <br /> me: Seaport Environmental Time Spent. <br /> Address- 675 Seaport Boulevard <br /> City, State, Zip: Redwood City,Ca 94063 Phone ft: (41S)V4-8194 <br /> 11 t t <br /> Approval V., 701-588 Received by. t 1NWLd <br /> (Typed 4r odnted(un name a signature) .(Dote) <br /> 1 ® ® <br /> 7 <br />