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0 <br /> NON - HAZARDOUS WATER TRANSPORT FORM Nufter <br /> GENERATOR INFORMATION <br /> CAL lrd,1111-0 <br /> Name: t1 0-1 <br /> — -0-'30ALtf <br /> Address., 1 'raw <br /> City, State, Zip. pt!P e 0. <br /> DESCRIPTION OF WATER: <br /> NON-HAZARDOUS WASTE WATER,MONITORINGWATER AND/OR AUGER WELL P ATE,TANK RINSATE. <br /> URGE RINS <br /> THIS WATER MAY CONTAIN DISSOLVED HYDROCARBONS.I CERTIFY THAT THE BELOW NAMED MATERIAL is A <br /> LIQUID EXEMPT FROM RCRA PER 40 CFR 261.4(b)(1Q) DOES NOT MEET THE CIMPIA OF HAZARDOUS WASTE AS <br /> DESCRIBED IN 22 CCR ARTICLE 11 OR ANY OTHERAPPUCAME STATE LAW,HAS BEEN PROpERLy DF SCRIBED, <br /> CLASSIFIED AND PACKAGED AND IS IN PROPER CtWDFTPON FOR TRANSPJRTATIONI ACCORDING TO APPUCABLE REGULATRWS. <br /> 3 <br /> L FG <br /> Generator/Authorised Agent SIGNture&Date <br /> SITE INFORMATION <br /> STA # JOB 0 TANK e.G USG <br /> 2 <br /> 3 <br /> 41- <br /> TOTAL GALLONS: <br /> TRANSPORTER INFORXTION; GROSS <br /> wGiTIr. TARE <br /> Name: W-C6V1r'&1 NET <br /> Address: r '14 <br /> �N 7. <br /> City, State, Zipj Phone!!SLI;���. <br /> Truck ID III: Driver. <br /> (Typed or printed fulf name&Signature) (Date) <br /> ............ <br /> DISPOSAL FACILITY INFORMATION: Time Out: <br /> Time In: <br /> Name: Seaport Environmental Time Spent: <br /> Address: 67S Seaport Boulevard <br /> City, State, Zip. Redwood City, Ca 94063 .Phone#: (415) 364 1024 <br /> Approval Slab Received b <br /> of printed ful name&signature) (Date) <br />