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NION® AAWaste Hauler Document Daily Field Ticket No. 45159 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name:alA;� —A460g, ' <br /> Name: Name: <br /> EPA# EPA# <br /> EPA# <br /> Address: . -11 Address: �A Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER ❑ - OTHER &4,nZE <br /> Weight/Volume ?� Units Container: ❑ - Dump Truck 'a- Tank Truck <br /> This materiarii nonhazardous because: <br /> 1)it isAjIrifiing 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 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 /> TRANSPORTER <br /> Warren E. Gomes Exc., Inc. Job No. ' Pick-Up Date ' <br /> P. O. Box 369 _ <br /> Rio Vista, CA 94571 Unit No. 2' <br /> (707) 374-2881 JW3NATURE OF BUYER <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Injection Well <br /> Name QTY Measured o - Landfill <br /> p - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS ❑ - OTHER ❑ - Surface Impoundment <br /> i f -er Other <br /> SIGNAT E OF XTHORIZED' GENT DATE <br /> TSDF TO GENERATOR <br />