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7LL-22E-1 g9E .3 cc [D J^1 [NC _y • P 04 <br /> IwM INC <br /> A�praval No NON-HAZARDOUS WATER TRANSPORT <br /> Ticket No <br /> 5P8-� <br /> CERTIFICATE OF DISPOSAL sP0727g8 _ <br />' GENERATOR FNFORK4,T10N CUSTOMER INFORMATION <br /> Name Southland Corporation Name nyM Inc <br />' -kddress 10220 SW Grmnburg Rd 470 Address 950 Ames Avenue <br /> Czrv, Stim Zrp Portland OR 97233 Cry, State, Zip MIlptta_5 CA 95035 <br /> Purl asc Order# <br /> rGENERATOR CERTIFICATION OF NON-HAZARDOUS WASTE <br /> Description of Water Excav=cn Dewaterm <br />' NON-HAZARDOUS WASTE WATgL MONrrORING WELL PURGE WATER ANDIOR AUGER RINSATE, TANK <br /> RINSATE OR ABOVE DESCRIBED WATER TEUS WATER MAY CONTAIN DISSOLVED HYDROCARBONS I <br />' CERTIFY THAT TEE BELOW NAMED MATERIAL IS A LIQUID EXE2 T FROM RCRA PER 40 CFR 261.4(B)(10) <br /> AND DOES NOT MEET THE CRITERIA OF HAZARDOUS WASTE AS DESCRMM 1N 22 CCR ARTICLE 1 I OR ANY <br /> OTHER APPLICABLE STATE LAW HAS BEEN PRCWERLY DESCRIBED CLASSIFIED AND PACKAG=AND IS <br /> IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TO APPLICABLE REGULATIONS <br /> Davi v =At4 rW_ 50uTgLW v ,- <br /> K4 n aril <br />' Generator/ Aurhortwd Agmt Sigature Date <br /> SITE INFdRMATION <br /> f M Job :.- Site;t Site Address #of Drum Callous <br /> 14117 2725 W Country CIub Blvd, Stockton. CA 5p� <br /> tEsarnsated Total A 5Lb <br /> TRANSPORTER IMFORMATION DISPOSAL FACTLTTY INFORMATION <br /> Name P- M, Inc NG CNE_[./} Name Seaport EnvmmmeuW <br /> Address 950 Anes Avrmue Address 675 Seaport Blvd <br />' Milpnas CA 95035 Port of Redwood Cay CA 94063 <br /> Phone 408-942-8955 Phone 650-364-1024 <br />' Truck LD ff- f <br /> Driver Name AN, s A <br /> ,�natu rg <br /> OC fTRAN-PRT FRM} <br /> { <br />