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NON—HAZARDOUS ante Hauler Document Dail Meld Ticket No. 45480 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: ccs 1 Name: yfl(:�T_ Name: <br /> EPA# EPA# EPA# <br /> Address: % I '� ' Address: ® �' /A,( Orr'd Address: <br /> Order;Rlaced: Order Date: `. <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER - 4T' OTHER?,'� <br /> Weight/Volume -� Units 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 hydroxise or sodium carbonate oil <br /> field boiler scrubber system, andpossesses no characteristics that would require its SIGNATURE OF AUTHORIZED AGENT DATE <br /> handling as a hazardous waste. <br /> TRANSPORTER j <br /> Warren E. Gomes Exc., Inc. Job No.Z3406rgortiidd_,/�� ' Pick-Up <br /> R 0. Box 369 <br /> Rio Vista, CA 94571 Unit No. d <br /> (707) 374-2881 TUREOFBUYER <br /> EPA#CA 3.70 <br /> b <br /> br, <br /> e � <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Injection Well <br /> -Name QTY Measured �` 6 ❑ - Landfill <br /> ❑ - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS OTHER ❑ - Surfac undment <br /> ❑ - Other <br /> SIGNA URE'OF AUTHOkAED AGENT,r' DATE <br /> TSDF TO GENERATOR <br />