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NON—HAZAR DOUS Waste Hauler Document Daily Field Ticket No. �'� 4 516 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: &-low Name: Name:— <br /> EPA# <br /> ame:EPA# EPA# EPA# <br /> Address: '""� ' Address:-�J � •�? '' � '� Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASELL WATER ❑ - OTHER <br /> Weight/Volume (9 Units__ 1 Container: ❑ - Dump Truck Tank 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 /> letter and contains no significant concentrations of toxic materials from natural sources,or <br /> 2)is a sulfur-dioxide scrubber solution from.a sodium hydroxiss 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 /> TRANSPORTER <br /> Warren E. Gomes Exc., Inc. Job No. 6 ` Pick-Up Date <br /> .P. O. Box 369 <br /> Rio Vista, CA 94571 Unit No. <br /> (707) 374-2881 r MINIATURE OF BUYER <br /> i <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> ly r� ❑ - Injection Well <br /> Name QTY Measured 3 t"� f ❑ - Landfill <br /> ❑ - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS •OTHER ❑ - Surface ImpoundeIt, <br /> - Other <br /> _Je4v"A"Al I <br /> SIGNA URE OF-AUTHORIZED A NT DATE <br /> TSDF TO GENERATOR <br />