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NONMHAZARDOUS aster l rl2 f 5' <br /> u e t-Dally Field Ticket No. <br /> 45478 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: <br /> Name: 4 Name: <br /> EPA# EPA#_ <br /> EPA# <br /> Address: .. r � Address: lloc-, AdAnt V Address: / <br /> Order Placed: Order Date: <br /> WASTE..,_, 0 - DRILLING MUD - ASWELL WATER 0"- OTHER -Pl ocq <br /> Weight/Volume / �/ Units Container: 0 - Dump Truck �k Truck <br /> This material is nonhazardous¢ecause: P.."J <br /> oo <br /> 1,):it is a drilling mud containing only the additives listed t; a Department in itsegemption <br /> letter and contains qo sige.micant concentrations of tope"materials from natural sources,or <br /> 2)is a sulfur-dioxide'scrubber solution from.a sodiuk-.Pydroxise or sodium carbonate oil <br /> field boiler scrubber system, and possesses no chkracteristics that would require its <br /> handling as a hazardous waste. SIGNATURE OF AUTHORIZED AGENT DATE <br /> TRANSPORTER1%0(volf ' Rd <br /> Warren E. Gomes Exc., Inc. Job No. >�e <br /> Pick-Up Date <br /> P. O: Box 369 <br /> Rio Vista, CA 94571 Unit No. <br /> -2 /0/ <br /> (707) 374-2881 1 SIG TURE OF BUYER <br /> EPA#�CAD076557370 <br /> TSD FACILITY <br /> Method of Disposal: <br /> - Injection Well <br /> Name QTY Measured o - Landfill <br /> o - Land Treetme <br /> EPA# ❑ - BBL ❑ - TONS - OTHER ❑ Surface Imp <br /> `F <br /> - Other <br /> 63 <br /> SIGNAT , OF AUTHORIZED AGENT DATE ' <br /> ti TSDF TO GENERATOR <br />