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Jurt-10-01 20 : 49 Seaport Petroleum 650 3641021 P.02 <br /> Seaport Environmental <br /> NON-HAZARDOUS WATER TRANSPORT FORM L:J 7177 <br /> : GENERATOR INFORMATION CUSTOMER INFORMATION <br /> Mel Boltides American Valley Waste ail <br /> 383 Moffett Blvd <br /> ' <br /> Mantecu CG <br /> I PO# <br /> DESCRIPTION OF WATER: MOnitoring Well Sampling <br /> ' NON-HAZARDOUS'HASTE WATER,NIONITORINQ WFLL KIR09 WATER ANDIOR AUGER RINSATE,TANK RIN$ATE OR AJ30YE <br /> DESCRIBED WATER.THIS WATER MAY CONTAIN DISSOLVED HYDROCAHklow;.I CERTIFY THAT THE ABOVE NAME()MATE141AL <br /> IL:A LJUUIU LALR11 I1 1 I tUAA 14UI lA 114I1 aV 074:Ikt1.4 (i3)(101AND DORI NOT MEET TWI C WTSWIA 06 1 L'%z&R041J9 WASTE AS <br /> DESCHIdEl)IN 22 OCR ARTICLE 11 OR ANY OTHER APPLIOABLE STATE LA'W,HAS BEEN PROPERLY DESQH1136b, <br /> CLASSIFIED ANO PACKAGEI?ANU IS IN PROPER CONDITION FOR 7RAIV3t 0KrATI()N ACCORDING TO APPLICABLE <br /> tRF,GULATIONR. <br /> tG©neratorrAuMatiSed Agent 8fgr7 date <br /> SITE INFORMATION <br /> 983 Moffett Blvd GROSS <br /> MCI(AUL.4 TARE <br /> ' Ca NET <br /> TOTAL CIAL LON S 34^ v () <br /> U41CWAied 11 0,34100 po• i J <br /> TRANSPORTER INFORMATION <br /> Truck 10; <br /> ' ATneriC.all Valley Waste all <br /> DTIvT: I <br /> l ��"? e ' `7 C_- <br /> Printfull name S sign data <br /> TIME OUT <br /> TIME IN <br /> TIME SPENT <br /> DISPOSAL FACILITY INFORMATION EPA ID;CAL 080032408 <br /> ' Seaport Environmental Approval Number Solids%Vvt PH <br /> 673 Seaport Boulevard 302 <br /> R40wppd city,Ca e411e3 <br /> ' Phono; {850}3641024 <br /> 15ollda SurahArga <br /> ¢lUSG <br /> 1 Raerivod by: <br /> Print full name S sign date <br />