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EnviroPacific <br /> P.O.Box 1053,Vacaville,CA 95696,(707)447-2106 <br /> GEC Lic.No.A-876019 <br /> NON-HAZARDOUS SOIL DISPOSAL DOCUMENT <br /> GENERATOR <br /> Name: Gerald Thiemann Name: Fortner Thiemann's Service <br /> Address: 327 Blossom Drive,Ripon,CA Address: 106 W.Second St.,Ripon,CA <br /> Contact: John Sellman Tel: (209)579-2221 Contact: John Sellman Tel: (209)'579-2221 <br /> CUSTOMER <br /> Name: ATC Associates Inc. Contact: John Sellman Tel: (209)579-2221 <br /> Address: 1117 Lone Palm Ave.,Suite B,Modesto,CA 95351 Proj.No.: 054.62605.0001 P.O.: W-12-54-0092 <br /> DESCRIPTION <br /> Description of Soil: Soil drill cuttings/drilling debris <br /> Quantity: 10 Units: Drums <br /> This non-hazardous soil consists of drill cuttings,soil sampling residues,excavation material,a combination thereof,or as described above. <br /> The described soil may contain hydrocarbons. I certify that the above named material has been properly described and classified according <br /> to applicable regulations and possesses no characteristics that would require its handling as a hazardous waste. - /, y� <br /> / \ Generator/Authorized Agent: J Ia 5 -1 r/� <br /> - pPrint <br /> �Name/Tdlo� ign Date <br /> TRANSPORTER <br /> Name: EnviroPacfic Name: Recelogy Hay Rd Landfill <br /> Address: P.O.Box 1053,Vacaville,CA Address: 6426 Hay Rd.,Vacaville,CA 95687 <br /> Tel: (707)447-2106 Proj.No.: 299 <br /> This material will be disposed of at the above referenced facility in <br /> accordance with applicable federal,state and local regulations. <br /> Driver: �n Waste Tracking No: 3009 <br /> t^— -6 - G► <br /> Removal Date <br /> EnvimPaeple <br />