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1 <br /> NON—HIAZARDOUG Waste .Hauler U eft Daily Field Ticket No. 1Z 1 / 45477 <br /> GENERATOR SIGNATED"TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: " Name: -� 1151 �° fl. <br /> Name: <br /> EPA# EPA# EPA# <br /> Address: 1 Pt Address: -' ���P-0— / Address: <br /> h 0 <br /> ` Order Placed: Order Date: <br /> ASTE ' ❑ - DRILLING MUD ❑ - GASWELL WATER E!rrOTHER / 'c�/d`1 <br /> Weight/Volume Units Container: ❑ - Dump Truck -C'f- Tank Truck <br /> his material is nonhazardous because: <br /> ,)it is a driiliing mud containing only the additives listed by the Department in its>exemption <br /> fiI tter and contains no significant concentrations of toxic materials from natural sources,or <br /> is a sulfur-dioxide scrubber solution f�i m.a sodium hydroxise or sodium carbonate oil <br /> lfi Id boiler scrubber system, and possess,no characteristics that would-require its SIGNATURE OF AUTHORIZED AGENT, DATE <br /> hi�ndling as a hazardous waste. <br /> t <br /> TRANSPORTER , C �a .C, <br /> Warre omes Exc., Inc. Job No. Pick-Up ate <br /> P. 4.: ox 369 <br /> Rio Vista, CA 94571 Unit No. j <br /> (707) 3},7,4-2881 SIGNATOR OF BUYER <br /> EPA#bAD076557370 <br /> TSD FACILITY ,- Method of Disposal: <br /> ❑ - Injection Well <br /> Name QTY Measured ❑ - Landfill <br /> 11 - Land Treatment <br /> EPA# $ ❑ - RBL ❑ - TONS ❑ -OTHER ❑ - Surface Imurnnt <br /> ---Other <br /> — <br /> SIGN �E OF AUTHORIZED AGENT DATE <br /> TSDF TO OENER#0R <br />