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PAGE 62 <br /> NON-HAZARDOUS NATER TRANSPORT FORM <br />' GENERATOR CUSTOMER <br /> Name. jv,4�anne: <br /> Address-_x Address, <br /> Phone. r o -'— A ,15-6?3 <br /> Phone; <br /> 1 <br /> DESCRIPTION <br /> Description of water: A <br /> Volume/Weight- 4 units. Container(s): <br /> This non-hazardous waste water is montoring well purge water,auger rinsate, sampling equipment rinsate,tank <br /> rinsate,combination thereof,or as described above Described water may contain dissolved hydrocarbons 1 certify <br /> that the above named material has been properly described and classitfed accord Eng to applicable regulations,and <br /> possesses no characteristics that would require its handling as a hazardous waste. <br />' Generator/Authorized Agent. y / f ° ��3�� e- <br /> Pant Sign Date <br /> TRANSPORTER <br />' Name Job No: �tl/ --- <br /> Address- Pick-up Date, <br />' Phan q q p—Q Truck- <br /> - 3�1.�.._.�. Driven <br /> Sign Date <br /> DISPOSAL FACILITY <br /> Name Z `f <br /> Address � Quantity. <br /> Units; — <br /> Dtspos o <br /> Received byA ( `` <br />` Print -d 4 <br /> $ Date <br />