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r r r r r r r r M r r r Mir M1 <br /> • 'a r <br /> NOIN.HAZARID06S Waste Hauler Document Daily Field Ticket No 37c4 49507 <br /> f <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name m'iat c-`CE TA .1r Name Ljna2&= _ Name <br /> i <br /> EPA # dd EPA # EPA # <br /> Addf,vas,° _ lAAQf W(--. IA31 - Address Addressi <br /> „[A <br /> Order Placed _ Order Date <br /> WASTE C) - DRILLING MUD ❑ - GASWELL WATER ® - OTHERV46Teg- <br /> + t <br /> Weight/Volume Units 1312� Container ❑ - Dump Truck R) - Tank Truck <br /> Th material Is nonhazardous because <br /> 1) Is a dnlliq mud containing only t4eadditives listed by the Department In Its exemption <br /> ,I let r and contains no significant concentrations of toxic materials from natural sources or <br /> 2 s a+sufturcll;oxkde scrubber solution from a sodium hydroxtse or sodium Carbonate oil <br /> fieid boder scrubber system and poasmes no characteristics that would require Its SIGNATURE OF AUTHORIZED AGENT DATE <br /> handling as a hazardous waste �3 <br /> 4 <br /> TRANSPORTER <br /> Warren E Gomes Exc , Inc Job No '°C+CTt~ Pick-Up Date L i. <br /> P O Box 369 , <br /> Roo Vista, CA 94571 ,Unit No 4429`` 9'07) 374-2881 M 51GNATURE OF BUYER <br /> EPA # CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> �-- o - Injection Well <br /> Name �� QTY Measured �'-•�^-� Q - Landfill <br /> -- - —- _-- -- -- -- - - - - -- - -- ------,- - - -� — - - -�-- at i Treat nA - -- -- -- - - - <br /> EPA # ❑ L BBL ❑ - TONS/Cl - OTHER ❑ - Surface Impoundnion f <br /> D—Other <br /> SIGNATURE Of AUTHORIZED AGENT DATE <br /> 1 <br /> TSDF TO GENERATOR <br />