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NON-HAZARDOUS Waste Hauler Document Daily Field Ticket No. ` s - 45164 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: Name: <br /> Name: <br /> EPA# EPA# <br /> EPA# <br /> Address: . 7-11 Address: 14/19 Address: <br /> Aft <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER ❑ - OTHERA <br /> Weight/Volume " Units Container: ❑ - Dump Truck �S- 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 <br /> handling as a hazardous waste. DATE <br /> TRANSPORTER <br /> Warren E. Gomes Exc., Inc. Job N0226'a Pic rup Date <br /> R O. Box 369 <br /> Rio Vista, CA 94571 Unit No. <br /> (707) 374-2881 PUNATURE OF BUYER <br /> EPA#.CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> Name 0 0 - Injection Well <br /> QTY Measured '" a - Landfill <br /> EPA# o - Land Treatment <br /> - BBL O - TONS ❑ - OTHER o - Surface Impcin nt <br /> Other— <br /> 6 <br /> kjw/5,o <br /> SIGNATURE _F A:,1THO ED AGENT DATE <br /> TSDF TO GENERATOR <br />