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NON-HAZARDOUS aste Hquler Documbrit Daily Field Ticket No. L� Z 45157 <br /> GENERATOR DESIGNATED TSD FA ILITY ALTERNATE TDS FACILITY <br /> -e <br /> Name: .a Name: r Name: <br /> EPA# EPA# EPA# <br /> Address: Address: I_ o, f ?0 VT Address: <br /> Order Placed: r Date: <br /> WASTE ❑ tLLNG MUD ❑ - GASWELL WATER OTHER <br /> +eight/Vo lume 70 Units 1, Container: ❑ - Dump TruckTank Truck <br /> This material is nonhazardous,because: <br /> 1)it is a drilling mud containing only the additives listed by the Department in its exemption <br /> tt letter and contains no significant concentrations of toxic materials from natural sources,or <br /> f 2)is a sulfur-dioxide scrubber solution froma sodium hydroxise or sodium carbonate oil <br /> field boiler scrubber system, and possesses no characteristics that would require its SIGNATURE OF AUTHORIZED AGENT DATE <br /> handling as a hazardous waste. <br /> i <br /> r <br /> TRANSPORTER <br /> Warren E. Gomes Exc., Inc. Job No. Pick-Up D to <br /> P. O. Box 369 <br /> Rio Vista, 044571 Unit No. <br /> (707) 374-2881 1�AT UYER <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Injection Well <br /> Name ` ' QTY Measured `< ❑ - Landfill <br /> r o - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS ❑ - OTHER ❑ 55nrface impg5Went <br /> op <br /> , "- Other <br /> SIG TURF OFAUTHORIZED AGENT ° DATE <br /> TSDF T ENEftATOR <br />