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Jun-OI-01 (74: 12 5eapt�rt P�trr�ls�um 650 3641021 P101 <br /> 1 <br /> r, Seaport Environmental <br /> NON-HAZARDOUS WATER TRANSPORT FORM <br />' GENERATOR INFORMATION CUSTOMER INFORMATION <br /> Advanoed Geo Ernvranmcrn,a American Valley Wade Oil <br />' vur ous <br /> Ca P0:# <br />' DESCRIPTION OF WATER Monitoring well development <br /> NON HAZARDOUS WAbTE WATER MONITORING VV'ELL PURGE WATSR ANDlOr7 AUGER RINSATE TANK HiNSATE OR DROVE <br /> DESCRIBED WATER THIS WATER MAY CONTAIN DISSOLVED HY+DROCAR60NS I CERTIFY THAT THE AaOVE NAMED MATERIAL <br /> lb A LIQUID EXEMPT rIKOV RCRA PER 40 CFR 261 4 (b)(10)AND DOES NOT MEET THE CRITERIA OF HAZARDOUS WASTE AS <br />' DEbCl2It3�D IN 12 CCR ARTICLE 11 OR ANY OTHeR APPLICABLE STATE LAW,HAS BEEN PROPERLY r1ESCRI8E0, <br /> CLASSIFIED AND PACKAGED AND IS IN PROPER CONDITION FOR TRAN6PORTATION ACCORDING TO APPUt ABLE <br /> ,REGULA IONS <br /> �s 4 I J <br />' Generator/Authorised Agent 8lgn date <br /> SITE INFORMATION <br /> Various GROSS D <br /> 12U l nnS r TARE <br /> NET <br /> TOTAL GALLONS <br /> _C%TrniPtvd sl s 34 ius pr r Li3i <br /> TRANSPORTER INFORMATION <br />' __ +American Valley Waste Oil True* to 1�4 <br /> Zrlvar. tri <br /> Print full name&sign I Cato <br /> TIME CUT <br /> TIME IN <br />' rime SPENT <br /> Y <br /> ViSPaSAL FAC IJTY IiN FORMATION EPk 10 GAL OOD032038 <br /> Seaport Envlronmeantat Approval Number Solids%wt PH <br /> 675 Seaport Boulevard 302 . 584 A ''� <br /> Redwood City,Ca 94063 1 <br />' Phan* (660)36A 1024 <br /> SoIlds Surcharge <br /> — � 1ruso <br /> �teCeiY6d by Y4&w,� <br /> G S D l W 9 711 <br /> Print fuil name&sign date <br /> I <br />