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NON-HAZARDOUS SteHauler CRS Daily Flea Ticket No. q/ z 1 <br /> 45482 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: i,•.,or Name:4— ! Name: <br /> EPA# EPA# i EPA# <br /> Address: Address://05 r <br /> Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER -OT."E-R EIX (CC", 1161141 <br /> Weight/Volume Units Container: ❑ --Dump Truck �- Tank Truck <br /> material is nonhazardous because: <br /> 1)it Tilling mud containing only the additives listed by the Department in its exemption <br /> letter an sins no significant concentrations of toxic materials from natural sources,or <br /> 2)is a sulfur de scrubber solution from.a sodium hydroxise or sodium carbonate oil <br /> field boiler scru stem, and possesses no characteristics that would require its SIGNATURE OF AUTHORIZED AGENT DATE <br /> handling as a hazardo ste. <br /> TRANSPORTER <br /> Warren E. Gomes Exc., Inc.. Job No 2 (21TIf ttA(Rd? l reL /r7-f1)1 Pick-UD <br /> P. O. Box 369 z <br /> Rio Vista, CA 94571 Unit No. / <br /> (707) 374-2881 SIGNAT RE OF BUYER <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> * 4 - Injection Well <br /> Name T QTY Measured ❑ - Landfill <br /> 0 - Land Treatment <br /> EPA# 0 - BBL ❑ - TONS ❑ -:OTHER ❑ - Surface Imp nt <br /> Other <br /> SIGNATURE OF AUTHORIZ GENT DATE <br /> R <br /> TSDF TO GENERATOR <br />