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HUL7-lJd-1770 1 C1 GO 1 L i wF I+ 11'0.. r kJ <br /> tWM. TMC <br /> AWrovul No NON-HAZARDOUS WATER TRANSPORT Ticl=No <br /> I CERTIFICATE OF DISPOSAL 5Pp73pg8 <br /> GENERATOR 1NFORMAnoN CUSTOMER INFORMATION <br /> Narm Southland C_Rg2ratton _ Name ML Inc <br /> Address _ 10220 SW gT!!2tug Rd, 470 Ad&ass 950 Ames Avenue <br /> C,tY• Sum.ZIP' Potttattd. OR 97233 City, State,Trp NEI 'tag, CA 95033 <br /> Pu=lm a Order 4 . <br /> GENERATOR CERTIFICATION OF NON-RAFARDOUS WASTE <br /> Descnpum of Waver Fxmv=m Dawatmm <br /> WW-IiAZARDOtJS WASTE WALTER MONrrORlNG WELL PURGE WAnM AND/OR AUGERRINSATE,TANK <br /> RINSATE OR ABOVE DESCROM WATER TWS WATER MAY CONTAIN DISSOLVED HYDROCARBONS I <br /> CERTIFY THAT THE IMAW NAMED MATERIAL IS A LJQ=E MMPT FROM RCRA PER 44 CFR 261.4(BXIO) <br /> AND DOES Nat MEET THE i STMtiA OF HAZAPM=WASTE AS DF.SCRZBID JN 22 CCR ARTICLE I 1 OR ANY <br /> CTEEE i APPLICABLE STATE LAW.HAS BEEN MCFERLY DESCRtB.ED CLASSMM AND PACKAGED AND 1S <br /> IN PROPER CQNDMCK FOR TRANSK)RTA-nON ACCORDM TO APPLICABLE REGULATIONS <br /> CMUWJl=rf Ait&=7 d Agan SLg=ar= Date <br /> SITE fNFORMATION <br /> 1W14M lob ;* See 0 Sne Addrus #of Drum Gallaas <br /> 14117 2725 W Couauv Club Btvd. Stoddm CA Sv <br /> Esmsated Tow Q � <br /> 'T'BANSFORTER MORMATION DISPOSAL FACILM LNFORMAIION <br /> Names 1K'M. I Namc Favuanmeaw <br /> Addrms 950 Ames Aw;nmc Addrm 675 5 Blvd <br /> nkn!.CA 93035 Part of Rertwoad_ Cites+ CA 94063 <br /> PSme 408-942-8955 T°bce 650-3641024 <br /> Tnick ID # <br /> Ewe <br /> DOC{TRANPRT FRM} <br /> TOTPL P 04 <br />