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05/27/2003 00:21 7536574 PAGE 02 <br /> r - <br /> NON.-HAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR CUSTOMER <br /> Name. Name. <br /> ' Address• ;~ Address: <br /> c A q 56e3 <br /> Phone: 3 31,E O Phone <br /> r <br /> DESCRIPTION <br /> r <br /> Dcscnption of water; AIL t <br /> Volume/Weight- 1.10 Units: Container(s)- <br /> This con-hazardous waste water is monitoring well purge water,auger rinsate,sampling equipment rinsate,tank <br /> rinsate,combination thereof,or as described above Described water may contain dissolved hydrocarbons I Certify <br /> that the above named matenal has been properly described and classified according to applicable reguiptions,and <br /> postesscs no characteristics that would require its handling as a hazardous wamo, <br /> Generator/Authorized Agent, 17 sell -7 <br /> TRANSPORTER Print Sign Date <br /> TRANSPORTER <br /> Name, <br /> 3 <br /> Address, � ob No <br /> Pick-up Date, <br /> Truck ID-Phone: „q 19`1Q3` <br /> Driver• Z-/S•d S <br /> 29n Date <br /> r DISPOSAL FACILITY <br /> Name: -T c <br /> ' Address: Quantity. <br /> y. <br /> Units: <br /> 16 <br /> Ay � Dispos th <br /> ' Received by: <br /> Pnnt <br /> Sign �--- <br /> Date <br /> r <br /> r <br /> 1 <br />