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05/?.8/200i FRI 15:04 FAX Z002/003 <br /> .s-21-1995 3.4.2AM r-1-14.1 i <br /> r <br /> I <br /> T��SLA 1sJ � b;. <br /> NON-HAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR INFORMATION CUSTOMER INFORMATION <br /> ��oo uJ �;rJ�s .v+XT�v 5iz Foss Environmental Services <br /> ��r�ic.�� CO.. �.TZG 3 <br /> PO # lbsq — <br /> DF-SCMP'TION OF WATER <br /> WASTE WATTK NONNTOMw WELL RAw WATdt ANQ/oR Am=RiNsATE. TANG RNSATE oR AeovE <br /> DESCMED WATER THS WATER MAY CONTAIN DISSOLVED HYDROCARBONS.I CMM THAT THE ABOVE NAMED MATERIAL <br /> LS A LIWD DOWr FROM RMA PER 40 CFR 261.4 (bX10)AND DOES NOT MEET TM afrMA OF MMMDOW WASTE AS <br /> DESOMM N 22 CCR ARTICLE 1 t OR ANY OTHBt APPLI AME STATE LAW.HAS BEEN PRINVILY DESCRIBED, <br /> CLASSIM AND PACKAGED AND IS W PROPER CONDITION FOR TRANWWAT10N AO=WING TO APPLICABLE <br /> REGULATIONS. <br /> Cf.4� l�- °f.,rl- 2I�3�1ao1 <br /> Gercret0T,0A0th"11ftd Agent: VQJ date <br /> 'SITE INFORMATION a <br /> GROSS <br /> TARE <br /> CA - NET <br /> TOTAL GALLONS Z po, �A� <br /> ad ac per u� <br /> TRANSPORTER INFORMATION . <br /> Truck ID: <br /> Fos$ Environmental <br /> Driver- .A., `� -Z_3 4Dr <br /> Print Ifts none d 4ign date <br /> TME OUT <br /> TWE N <br /> ]LME SPENT <br /> DISPOSAL FACILITY INFORMATION <br /> Seaport Environmental Approval Number Solids %Wt pH <br /> 675 Seaport Boulevard <br /> Redwood city, Ca 94063 <br /> Phone: (650) 364 1024 <br /> Solids Surcharge <br /> a/USG <br /> Received by: <br /> Prins,full name & sign date <br />