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NON-HAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR CUSTOMER <br /> Name: Ag Station _ Name. Doulos Environmental, Inc. <br /> Address: 503 East 10th Street Address: P. O. Box 2559 <br /> Tracy CA^ - _ _ Orangevale, CA 95562 <br /> Phone: - (775) 851-7240 Phone: 916-990-0333 <br /> DESCRIPTION <br /> Ld Description of Water : Purge water from Monitorinp, Wells <br /> Volume/Weight: `J 6 Units: gallons Container(s): PolyTank�T <br /> 60 <br /> This non-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 that <br /> the above named material has been properly described and classified according to applicable regulations,and possesses <br /> Lathe <br /> characteristics hat would require its handling as hazardous waste. <br /> 6.0 Generator/Authorized Agent: Hal Hansen <br /> t — <br /> Print Sign Date <br /> TRANSPORTER <br /> Name: Doulos Environmental Job No: NA <br /> `# Address: P. O. Box 2559 Pick-up Date: <br /> Orangevale, CA 95662Truck ID: NA <br /> Phone: 916-990-0333 T Driver: - -Zj Wiz_ <br /> Sign Date <br /> DISPOSAL FACILITY <br /> La Name: InStrat Inc. Quantity: <br /> Address: P. O. Box 2279 Units: gallons <br /> Davis, CA Disposal Method: <br /> Received by: I/ d� <br /> Print Sign Date <br /> Nr <br />