Laserfiche WebLink
_ VL\4 VlM ffA1Ll\ ��Vf <br /> JLL_-RB-159B !422ID IWM, INC P 04 <br /> [WM, 1NC <br /> Approval No NON-HAZARDOUS WATER TRANSPORT Ticl�ec No <br /> 5F-5-BCL-RTIFICATE OF DISPOSAL sm72mgb <br /> GENERATOR INFORMATION CUSTOMER INFORMATION <br /> Nage Southland Corporation Name IWhI_ Inc <br />' Address 10220 SW GreenbM Rd 470 Address 950 Ames Avenue <br /> City, State Zip Portland. OR 97233 City, State, Zip Nfil ita_s CA 95035 <br /> Purchase Order it <br /> GENERATOR CERTMCATiON OF NON-HALARDOUS WASTE <br /> Descnpuon of Water Excavauca Dewaterm <br /> NON-HAZARDOUS WASTE WATER.MONITORING WELL PURGE WATER ANI)A3R AUGER R'NSATF-TANK <br /> I�INSATE OR ABOVE DESCRIBED WATER Tf-I1S WATER MAY CONTAIN DISSOLVED HYDROCARBONS I <br /> CERTIFY THAT THE BELOW NAMED MATERI AL IS A LIQUID EXEMPT FROM RCRA PER 40 CFR 251 4(B)(10) <br />' AND DOES NOT MEET THE CRITERIA OF HAZARDOUS WASTE As DEscP-mm IN ZZ CCR ARTICLE 11 OR ANY <br /> O'iBRR APPLICABLE STATE LAW,HAS BEEN PROPERLY DESCRIBED CLASSIF= AND PACKAGE] AND IS <br /> IN pROPER CONDMON FOR TRANSPORTATION ACCORDING To APPLICABLE REGULATIONS <br /> RAVi v GSA t eIZ SGuru LA#4V !� n o4 — oil, <br /> Generator/ Aiiihonzcd Agsut Stgmature Date <br /> SITE INFORMATION <br /> IWM Sob 4 Srte# Site Address #of Drum 11 Gallons <br /> 14117 2725W Country Club Blvd, Stockton CA _ 31 2-Do <br /> 1 <br /> Eszuriacted Total 3 <br /> 5-00 <br /> INFORMATION <br /> T RANSpORTER INFORMATION DISPOSAL FACILITY <br /> Name 1WM, Inc Name S=ort FnviramenW <br /> Address 950 Ames Ague Address 675 Seaport Blvd <br /> , CA 9503 5Port of Redwood City CA 94063 <br /> Phone 408-942-8955 Phone _77:3 64-1024 <br /> I ' <br /> Truck ID 9- 1 <br /> 7 <br /> 1ZIIY�T NaIi1C 1LL S1g13t1].r0 <br /> DOC(TRANPRT FRM) <br />