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1N <br /> NON-HAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR CUSTOMER <br /> ' Name Ag Station Name- Ramage Environmental, Inc <br /> Address 392 S Moffat Address _ 465 S Meadows Pka., Ste 20 <br /> Manteci6 CA Reno,NV 89521 <br /> Phone (216) 99Q 333 Phone _ 775-851-7239 <br /> r DESCRIPTION <br /> Description of Water _ _Purge water from Momltoring Wells <br /> Volume/Weight Zv Units gallons Contmner(s) Poly Tank <br /> This non-hazardous waste water is monitoring well purge water,auger nasate,sampling equipment rinsate,tank <br /> ansate,combination thereof,or as described above Described water may contain dissolved hydrocarbons.I certify that <br /> the above named material has been properly described and classified according to applicable regulations,and possesses <br /> no characteristics hat would require its handling as hazardous waste <br /> Generator/Authorized Agent: Hal Hansen r -&3_-e26 <br /> Print Sign Date <br /> TRANSPORTER <br /> Name- Doulos Environmental Job No- NA <br /> Address. P. O Box 2559 Pick-up Date• <br /> Oran evale CA 95662 Truck ID. NA <br /> Phone __916m:990-0333 Driver. <br /> Sign Date <br /> DISPOSAL FACILITY <br /> Name- InStrat Inc. Quantity <br /> Address- P O Box 2279 Units. 4kjo <br /> rDavis CA .--. <br /> Received by: -6(0 <br /> ' Print Date <br />