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Eta = ' M M M M M m s� <br /> N &HAZARDOUS Waste Hauler Document Dally Field Ticket No d 49546 <br /> -- 1 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name Name Name <br /> , <br /> EPA # D110 i K= EPA# EPA# <br /> Address 2 —(2-212 � Address Address <br /> Qq ,,(A I <br /> Order Placed Order Date <br /> Rr+W—�'4�nYlM� +� <br /> " <br /> WASTE' ❑ - DRILLING MUD El - GASWELL WATERS - OTHER ; <br /> Weight/Volume ( Units Container ❑ - Dump Truck - Tank Truck <br /> This material is nonhazardous because <br /> 1)it is a drilling mud containing only the additives listed by the Department in Its exemption <br /> letter and contains no significant concentrations of toxic materials from natural sources or <br /> 2)is a sulfur-dioxide scrubber solution from a sodium hydroxise or sodium carbonate oil <br /> field boiler scrubber system and possesses no characteristics that would require its SIGNATURE OF AUTHORIZED AGENT DATE <br /> handling as a hazardous waste <br /> I I <br /> �' TRANSPORTER r� <br /> r Warren E Games Exc , Inc _ Job No aQ ` Pick p DAIA <br /> P O Box 369 ' <br /> Rio Vista, CA 94571 Unit No `'� �� -gip' C <br /> SIGNATURE OF BUYER <br /> (707) 374-2881 <br /> EPA# CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Infection Well <br /> Name QTY Measured ❑ - Landfill <br /> ❑ - Land Treatment F <br /> F EPA# ❑ - BBL ❑ - TONS ❑ - OTHER ❑ - Surface Impoundment <br /> o - Other <br /> a <br /> r i <br /> SIGNATURE OF AUTHORIZED AGENII DATE _ 4 <br /> I GENERATOR COPY <br />