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• <br /> LIQUID WASTE MANAGEMENT, INC. 42482 <br /> STAR RTE. BOX 4, CORNER HWY. 33 AND HWY. 58 <br /> MCKITTRICK, CA 93251 <br /> (805) 762-7366 Approval# <br /> ' Lease Scale Ticket # <br /> Well# 7 <br /> Ph# <br /> ' Approved Disposal Site Operator <br /> ' McKITTRICK LIQUID WASTE MANAGEMENT, INC. <br /> LIQUID WASTE DISCHARGE REPORT <br /> A. Liquid Waste Source: <br /> Company n <br /> ' Address <br /> Description: Soil ❑ Brine ❑ Drilling Mud ❑ Other <br /> ' B. Licensed Waste Hauler <br /> Company y� �a�7 • l o <br /> 1 Address <br /> Truck l <br /> ' C. Delivery Date: D. Invoice: Hauler <br /> Date: 4- --2 — ���/ Waste Source <br /> ' Quantity ns Wash Out @ $ ea. <br /> Cost Per Ton Total Cost <br /> 'I certify that the above described waste was hauled to this approved disposal site and was an acceptabl <br /> waste as es b fished b der No. 72-256 of the California Regional W er Quality Co rol Board <br /> gnature of Licensed Hauler <br /> Signatureisposal Site Operator HAULER Si <br />