Laserfiche WebLink
NON - EAAZAROOUS WATER TRANSPORT FORM Number <br /> Q G,�.!'D L,U Ut.Qa.el•*rtrJT�f.[ <br /> CXtiEiZAi�OR IttFORMA710N <br /> Name <br /> ' Address <br /> P <br /> City, State, ZipPhone# 4Z0 -s` <br /> DESCRIPTION OF,WATER <br /> ' NON-HAZARDOUS WASTE WATER MONITORING WELL.PURGE WATER ANO/OR AUGER RINSATE,TANK RINSATE <br /> THIS WATER MAY CONTAIN DISSOLVED HYDROCARBONS 1 CERTIFY THAT THE BELOW NAMED MATERIAL IS A <br /> UWu EXEMPT FROM RCRA PER 40 CFR 261 4(b)(7 O)AND DOES NOT MEET THE CRITERIA OF HAZARDOUS WASTE AS <br /> DESCRIBED IN 22 CCR ARTICLE I 1 OR ANY OTHER APPUCABL F-STATE LAW HAS BEEN PROPERLY DESCRIBED, <br /> ' CLASSIFIED AND PACKAGED AND IS IN PROPER CONDMON FOR TRANSPORTATION ACCORDING TO APPLICABLE REGULATIONS <br /> G <br /> Generator/Authonsed Agent Signature& Date <br /> ' SITE 'INFORMATION <br /> STA j j06 = f TANK = <br /> USGI <br /> 1 1 � <br /> I <br /> G i <br /> G—Ll--O-\S I ' <br /> T SAP:S�.:>R�='._..�..'"uRt•.,T1CtJ <br /> _ TARE <br /> i f L NET <br /> Na m:y <br /> - u G TOTAL GALLONS <br /> Address �}�}iA �i�c,lc-20 <br /> City, State, Zlr, — 4 P,¢ Phcrne : 2WZ- 7-f7-�Ch <br /> I <br /> llj <br /> i, ed ar r>r iced fu'l r & Srgnawre) (Daip) <br /> t I}I�'o5„L I r.r lir ItiI(.IViAI10 'Time Out <br /> „�jTlme In <br /> i`ame Se3por t anvirollr,ent�' i Ime Spent <br /> ' Addrr25- C'i S Scallor t. 3oulevard <br /> yrr Cr=Y St- u- / ,,/ I:edwood Qiv rD 9r10,K e 41 <br /> 'cc( w( d b), <br /> r � n <br /> SPC rl or ,,+u, r r! iii nun, �, vril ilufr l l <br /> 4 <br /> r y, <br /> Y <br />