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NON-HAZARDOUS Waste Hauler Document Daily Field Ticket No. F13 9 7J 80482 <br /> I <br /> GENERATOR DESIGNATED TTSSID FACILITY ALTERNATE TDS FACILITY <br /> Name: r�z A- Name: ��l✓`Q�"`�" Name: <br /> EPA# EPA# EPA # <br /> �� .� <br /> Address= 2��� //� � Address: /��144 � Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD `� El - GASWELL WA ER �' OTHE <br /> Weight/Volume ".�! Units gam�" Contain 6. <br /> ❑ - Dump Truck 502 Tank Truck <br /> This material is nonhazardous cede use: <br /> 1)it is a drllling mud contain!no only the additives tided by the Department in its exemption <br /> letter and corteinsno significant concentrations of toxic materials from noturalsources,or ./ V <br /> 2) Is a sulfur-dioxide scrubber solution from a sodium hydroxise or sodium carbonate oil <br /> field boiler scrubber system, and possesses no characteristics that would require its $IONAT R OF AUTHORIZED AGENT DATE <br /> handling as a hazardous waste ///'' <br /> TRANSPORTER ��/ (X! ` <br /> Warren E Gomes Exc., Inc. Job No.. � Pic p Date ✓— i <br /> _ <br /> P. 0. Box 369 <br /> Pic Vista, CA 94571 Unit No. <br /> 707) 374-2881 SIGNATURE OF BUYER <br /> EPA #CA007655737U <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Injection Well <br /> Name Sv ._. QTY Measuredd ❑- Landfill <br /> ❑ - Land Treatment <br /> EPA # El - BBL ❑ - TONS EI - OTHER o -p(,rface IpapAuydment <br /> _ ____ � �! P Other <br /> SIGNATURE OF F UTHORiZEU AGENT DATE <br /> ,4V 1 SDF COPY <br />