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NON-HAZARDOUS Waste Hauler Document Daily f=ield Ticket No. _ <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: - -- -- - - Name: Name: —. <br /> EPA # EPA # EPA # <br /> Address: .._. — Address: --_—. _ . . _ - Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER ❑ - OTHER - _-_- <br /> WeightlVolume Units Container: ❑ - Dump Truck ❑ - Tank Truck <br /> This rnateriah is nonhazardous because: <br /> J it is a drilling mud contain ng only the aclCitives'is'ed by ttie Depariment.n,ts exernpbor, <br /> Ietterand contains no significant concentrations c!'nxic rnalensls t,cm nstural sources,or <br /> 21is a sulfur dioxide scrubber solution from a sodiam hvdroxlse or sodium carbonate oil <br /> field boiler scrubber system. and possesses no characteri5l thal would require its SIGNATURE OF AUTHORIZE)AGENI GATE <br /> handling as a hazardous waste. <br /> TRANSPORTER <br /> Warren E. Gomes Exc., Inc. Job No. — Pick-Up Date <br /> P. 0_ Box 369 <br /> Rio Vista, CA 94571 Unit No. . ...__. — SIGNATURE OF 6UYER <br /> (707) 374-2881 <br /> EPA # CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> ° - Injection Well <br /> Name QTY measured Landfill <br /> ID - Land Treatment <br /> EPA __ El - BBL - TONS ❑ - OTHER ❑ - Surface Impoundment <br /> ❑ - Other- ___-- -_- <br /> Lr NnlJEof aUTHriRl=n GENT — — — r)a'rF <br />