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Waste 1u'et" Document*Daily Field Ticket No.. r <br /> 43277 <br /> GENERATO'R,A,` DESIGNATED TSD FACILITYALTERNATE TDS FACILITY <br /> Name.: t�. t,., t✓ Name: � t Name: <br /> EPA# EPA# EPA# <br /> Address: Address: 0 Address: <br /> i <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASELL WATER 0- OTHER_��(/�` /fin <br /> Weight/Volume RIMUnits Container: ❑ - Dump Truck ank Truck <br /> This material is nonhazardous because: <br /> 1)it is a drilling mud containing onlythe additives listed by the Department in its exemption <br /> letter and contains no significant concentrations of toxic materials from natural sources,or <br /> 2)is a sulfur-dioxide scrubber solution from a sodium hydroxise or sodium carbonate oil <br /> fieldboiler scrubber system, and possesses no characteristics that would require its SIGNATURE OF AUTHORIZED AGENT DATE <br /> handling as a hazardous waste. <br /> TRANSPORTER r <br /> Warren E. Gomes Exc., Inc. Job No.2 Q tigPick-U D r o3 <br /> P.. O. Box 369 <br /> Rio Vista, CA 94571 Unit No. 2- _ <br /> (707) 374-2881 SIGNATURE OF BUYER <br /> EPA#CAD076557370 ` <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Injection Well <br /> Name ; QTY Measured -� ❑ - <br /> �`-''�~�"�`� Landfill <br /> ❑ - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS - OT41i 13 - Surface I�fap undment <br /> -- Other <br /> r <br /> :SIGNRE OF AU ORI D AGENT DATE <br /> TSDF TO GENERATOR <br />