Laserfiche WebLink
Approval No. <br /> Ticket No. <br /> IWM, INC. <br /> L_ SP912216 NON-IiAZARDOUS WATER TRANSPORT <br /> CERTIFICATE OF DISPOSAL <br /> GENERATOR INFORMATION CUSTOMER INFORMATION <br /> Name: American Savings Name: American Savings <br /> Address: Address: 222 No. Eldorado St. <br /> City, State, Zip: City, State, Zip: Stockton, CA <br /> PO#: <br /> Description of Water: Monitoring Well Water <br /> NON-HAZARDOUS WASTE WATER, MONITORING WELL PURGE WATER AND/OR AUGER RJNSATE, <br /> TANK RINSATE OR ABOVE DESCRIBED WATER. THIS WATER MAY CONTAIN DISSOLVED <br /> HYDROCARBONS. GENERATOR CERTIFIES THAT THE BELOW NAMED MATERIAL IS A LIQUID <br /> EXEMPT FROM RCRA PER 40 CFR 261.4(B)(10) AND DOES NOT MEET THE CRITERIA OF <br /> HAZARDOUS WASTE AS DESCRIBED IN 22 CCR ARTICLE 11 OR ANY OTHER APPLICABLE STATE <br /> LAW, HAS BEEN PROPERLY DESCRIBED, CLASSIFIED AND PACKAGED AND IS IN PROPER <br /> CONDITION FOR TRANSPORTATION ACCORDING TO APPLICABLE REGULATIONS. <br /> SITE INFORMATION <br /> IWM Job # Generator Site Address 4 of Drum Gallons <br /> 90484-DW Amcrican Say. 222 No. Eldorado St. —Stocton, CA 2 <br /> Estimated Total IL2 <br /> TRANSPORTER INFORMATION DISPOSAL FACILITY INFORMATION <br /> Name: [VIM, Inc. Name: Seaport Environmental <br /> Address: 950 Ames Avenue Address: 675 Seaport Blvd <br /> _Milpitas, CA 95035 Redwood City, CA 94063 <br /> Phone: 408-942-8955 Phone: 650-364-1024 <br /> Truck ID #: 102-103 <br /> Driver Name: E�__ lSignature Date <br /> NUM CERTIFIES THAT THIS NON-HAZARDOUS WASTE WATER WILL BE TREATED AND DISPOSED <br /> AT SEAPORT ENVIRONMENTAL IN ACCORDANCE WITH APPLICABLE FEDERAL, STATE, AND <br /> LOCAL REGULATIONS. <br /> TomDelon .- <br /> Printed Name & Signature Date <br /> DOC(TRANPRT.FRM) <br />