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... <br /> 06/12/97 11:00 GR/GSI-SACTO - l lJM 002 <br /> 7UH-12-19V 11J:rF3 IG: IWM, [PIC. P.OS <br /> TP NUMBER: MILa(o23 <br /> NON-HAZARDOUS WATER TRANSPORT FORM <br /> (;F.,NERATOY� e ORMATTON <br /> NAME. Winner Pord <br /> ADDRESS: 1650 Park Street <br /> ('TTY.S'1'ATE.ZIP: Alamrtla, CA 94501 PHONE M: 510-865-3673- <br /> Iim-k{➢T4)N pig WATER:M0.4TTr)WG WELL YfArir�M ON WATZI <br /> I MTUrY THAT TH17 M.%'ITK AL IN A LIQIMI,t CMM PROU XCRA M a CrK 2/1.4{111(101 ANI)M33N <br /> NOT 1d1YYTX%CR1TFiva Or uAIAIIDOSIC WAM AJ DR1M0101N M tTN AM'rl(LC t I OR ANY OTIMII APPUCA21 N <br /> aITATa LAW.IIAI SM PROPFALT DUCACMAh{-tA-'TTM AND PACI:AC D AND 13 W MOPI.'k VONI WKIN AOA <br /> T'XMIEPdRTATION ACCORDING TO 4U7Ltr'A0t9 l9rMAT)ON9 <br /> &Ira ..�L2�Yr7 <br /> GE ,,ER�Ta /�►U7�H01tIZfJ? AGENT SIO RE&DATE~ - �_----- -- <br /> SITE INFORMATION l✓ m <br /> Site Opnrdtor Addm& Gals <br /> Winner Ford _ 1615 11th Streer Tracy, CA Z�U <br /> TOTAL.GALLONS: 2�D <br /> TRANSPOR,rm uvF'oRmAnON <br /> NAME: IWM, Inc._ --_-- -- <br /> ADDRESS: 950 Ames Avtlnue -- <br /> CITY.STAITT,ZIP: Mil iters, CA 95035 PHONE# FOA 942-8955 _ <br /> TRUCK IT) rr: <br /> - (Typed or printed Ul nrlme&sigoatura) (Data) <br /> RECEIVING FACILM <br /> NAME: McKittrlck WTSI IWM. Inc. _ <br /> AJ)DIU.-'SS: 56533 H_wv SBW <br /> CITY.STATf7-,7)P: McKittrick. CA 93251 PHONE #: L�05)762.7366 <br /> APPROVAL H ` bits <br /> ( ypr or printed full nArw&sign=tunv) <br /> narwl F'.1�� <br />