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Waste Hauler Document Daily Field Ticket No. 14 to ' 7 45158 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: Name: Name: <br /> EPA# EPA# EPA# <br /> Address: _ 77 fl C4 Address: 1��r t�� Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER ❑ - OTHER <br /> WeightNolume I I- Units 6 5 Container: ❑ - Dump Truck ;T= 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 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 f <br /> Warren E. Gomes Exc., Inc. Job No. . � � Pick-Up Date 6 <br /> P. O. Box 369 <br /> Rio Vista, CA 94571 Unit No. 1`aL- <br /> (707) 374-2881 S GNATURE OF BUYER <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> Name � . ❑ - Injection Well <br /> QTY Measured --' ❑ - Landfill <br /> ❑ - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS ❑ - OTHER ❑ - rface Impourrfcfmm n <br /> _ o t h e r <br /> SIGNATURE OF AUTHORIZED A INT DATE <br /> TSDF TO GENERATOR <br />