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Y ` 51111 <br /> N ®HAZAWaste Hauler Document Daily Field Ticket No. o 7e-1 45156 <br /> GENERATOR. DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: Name: <br /> Name: <br /> EPA# EPA# <br /> EPA# <br /> 7-// Address: ��`,+ <br /> Address: <br /> � 49 � Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER ❑ - OTHER <br /> Weight/Volume j a Units Container: ❑ - Dump Truck - Tank Truck <br /> This material is nonhazardous because: <br /> 1)it is a.drilling mud containing only the additives listed by the Department in its exemption <br /> le..tter and contains no significant concentrations of toxic materials from natural sources,or <br /> 2)is a sulfur-dioxide scrubber solution from.a sodium hydroxise or sodium carbonate oil <br /> field boiler scrubber system, and possesses no characteristics that would require its SIGNATURE OF AUTHORIZED AGENT <br /> handling as a hazardous waste. DATE <br /> TRANSPORTER <br /> Warren E. Gomes Exc., Inc. Job No: s � P Pick-Up Date Y,; 'a <br /> P. O. Box 369 <br /> RioQyista, CA 94571 Unit No. <br /> s <br /> (707) 3,74-28$1 S GNA7URE OF BUYER <br /> EPA#6AD076557370 <br /> TSD FACILITY Method of Disposal: <br /> Named ❑ - Injection Well <br /> QTY Measured ❑ - Landfill <br /> ❑ - Land Treatment <br /> EPA# 0 - BBL O - TONS ❑ - OTHER ❑ - Surface klImpoundrqn <br /> -16- Other <br /> kou!k <br /> SIGNATURE OF AUTHORIZED AGENTDATE <br /> TSDF TO GENERATOR <br />