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1 <br />' Generator Information <br /> Name- 3 B'S <br />' Address 14749 N THORNTON RD LODI <br /> Description of water Non-Haz purge water UST Sites <br /> Basis for determination that water is non haz Analytical <br /> Generator/Authorized agent_ Y o} <br />' Print sign date <br /> Transporter Information <br />' Company name American Valley Waste Oil <br /> Truck Id Driver <br />' Print sign date <br /> Total Gallons S <br /> Facility Information <br />' Cascade General Inc Approval Number 700-085 <br /> 5555 N Channel <br />' Portland, OR 97217 <br /> ORD 18761934 <br /> Via Railcar 4 <br />' Received by <br /> Print full name and sign date <br /> 1 <br /> 1 <br /> 1 <br /> i <br /> 1 <br /> i <br /> I <br />