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J1l022U4.19FAX 510 287 OWBSOURCE CTL �U01 <br /> 0f 1Pp1orooKeforcl inerz09 7�� 9773 P <br /> 07/11/02 TMTJ 14:01 FAX 510 287­a21 EBst1ID 501510E CCL 1c1a02 <br /> .IitTRUCKED NON-HAZARDOUS WASTE <br /> EFBM� DISPOSAL PERMIT Terms and Conditions <br /> Liquid W2ste Acceptance Agreement <br /> 1) Permit Holder: Copperford,LL.0 <br /> 2.) Pcnnir Nnmher:2241 <br /> 3) Discharge Number: 2241 A <br /> 4) Source of Material to discharge: <br /> Company Name Address 61C <br /> vto" <br /> ilCgition fss4wted Volume <br /> (gallDnslmcasured unit <br /> Cep#aJwd,LLC 11d70 Locke 1[wd,Bldg. 100 Wintry wash( ' <br /> Leckdord,CA 95217 water At 19.�'in.toes <br /> S) Transporter Information <br /> ETrznspo�ar�mPany?4.�and Tuck Dexription Tyvck Torek 1 b. Truccor I.D. Tank <br /> bcr Lice seNumber NuAsber Capae,ry <br /> Numbcr silent <br /> erghi Luw See Anacb. -.70 <br /> 6) Describe ktsown and potential pollutants in this w;u(e <br /> Wine Lae4,1CMBS,Bentonite <br /> 7) Fccs for DisrharEa of Truckod Wnstc <br /> Copperford, LLC shall pay O ) / pilon for hauled truck weyte discharged to the <br /> E➢MLD W WTP. The fees billed for the di.chargc will he calculated hosed upon the <br /> full volume or the traruport vehicle.. The District will bill wa6te transporters monthly. <br /> Pcrmit Hol r Signature <br /> —Z/—//A _ <br /> S at Date <br />