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NON-HAZARDOUS Waste Hauler Document Daily Field Ticket No. q/ 3 d 2 45161 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: Name: ® Name: <br /> EPA# EPA# EPA# <br /> Address: - Address: 9 <br /> Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL ❑ - OTHER <br /> Weight/Volume Units ' �". Container: ❑ - DumpT - <br /> ruck ,� 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 /> fetter 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 No. .- 3tePick-Up Date_V <br /> P O. Box 369 <br /> Rio Vista, CA 94571 ` <br /> Unit No. <br /> (707) 374-2881Ah <br /> �i S ATURE OF BUYER <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> Name <br /> 41 � ❑ - Injection Well <br /> - QTY Measured PP ❑ - Landfill <br /> ❑ - Land Treatment <br /> EPA# ❑ - BSL ❑ - TONS ❑ - OTHER ❑ - Surface Impoundgae�tt„ <br /> Other "T�' L. <br /> SIGNATURE OF AUTHORIZED A ENT DATE <br /> 3 <br /> TSDF TO GENERATOR <br />