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.f11-HAZQRJSWaste Hauler.Documer ��ai� Ft��d T��I<et No:' '� <br /> R , x :4{* `Df�IGNATED T5D FAGF�ITY, ALTERNATE TDS FACILITY <br /> „ <br /> Name..= EDj Na Name. <br /> EISA# , <br /> `L EPS#' EPA#, <br /> ``Address F 1 <br /> ,Address: <br /> {Ord#r Placed; Ortler Date:i <br /> WASTE ; ❑ G MUD ❑ - G14SWELL WATER - OTH99 ER. <br /> t e tt/ q�unis Units Container: ❑rjj <br /> ck V- Tank TrUok <br /> W <br /> �hrs malarial is nbptiazardous t19q'du>}e. i <br /> `i.)d Is a drilling mud contamint6-oniyYtt�a a 10 Ives tlsfed by the.pepaRmentqj <br /> In its ezemptlon <br /> 1�ttecariii contains no,signiflc�nt�plYes t j1ohs of toxic materials'from natural'sources,or f <br /> 2)is a s,'ulfur dioxide scrubber spll}ttr #rdP A sodii rn hydroxise or sodium carbonate oil <br /> held boiler scrubber system.;aptly x saws no'eflar8ote�lstics-that would.require its_ 51r3NATURf QF ALfTHORIZED AGENT DATE. <br /> aridling as a hazardous wastd <br /> - <br /> T.RANSP.ORTER <br /> p} <br /> � r <br /> x Warren.E. Gomes, xc. I� = ob:N <br /> _ �7C.., . . •J o.' Pic Da <br /> •r <br /> 5 <br /> P <br /> P O Box 569: <br /> Rio Vista; CA 9457- <br /> (707) <br /> 457Unit Na <br /> i <br /> '+/ _A OFBUYER(707)_374-2581 :' >f� r <br /> �s A <br /> EPA.CCAD076557370 <br /> TSD FACILITY f ;- Meth 'd;of Disposal: <br /> w 4 -'Injection Well': <br /> Name OQTI�'Measured -C� �_ o Landfill <br /> }4 T ❑ - Land Treatment <br /> >=PA.# �� ❑ -BBL .p =TOEVS ©=; 'HER �.-Surface #mpoundmenk <br /> • ;� :rte t�� .o:.,, Other ��� <br /> 5 <br /> =SIGNATURE OF A THOAIEED F�Q�N c -w � � DA <br /> .., , ._,K. .w..,.. . TSDF TQ:GE{ XI R: . <br />