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r <br /> NON-HAZARDQUS Waste 'Hauler' Documeiht Daily Field Ticket No. 45483 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> NameKName: _ --� <br /> Name: <br /> EPA# EPA# EPA# <br /> d / F <br /> Address: Address: �rP � � Address: <br /> Order Placed: Order Date: <br /> WASTE ❑"- DRILLING MUD ❑ - GASWELL WATER - OTHER <br /> Weight/Volume Units Container: ❑ - Dump Truck Z= Tank Truck <br /> This material is nonhazardous becauee: <br /> 1)it is a drilling mud containing only the additives listed by the Department in its exemption <br /> letterand contains no significant concentrations of toxic materials from natural$ources,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 <br /> E®GomEsRExc., Inc. Job No. 6KQ�7 61 a �'C2�' 7 11 �• Q _.,' <br /> Ptck-Up Date t J <br /> _.Q O: Box 369 <br /> Rio Vista, CA•94571 Unit Na `°- <br /> (707) 374-2 <br /> 8 <br /> 81 SIGN�TUREO UYER <br /> t� <br /> EPA#CAD076557370 <br /> TSD F14CILfTY Method of Disposal: <br /> t-�--'�r--- o - Injection Well <br /> Name QTY Measured ❑ - Landfill <br /> ❑ -Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS ❑ - OTHER ❑ - Surface ImpeeuuApent <br /> -.-0-:7-Other ��`��C-�-, <br /> SIGNATU&E'OF AUTHORIZED AGENT DATE <br /> ,•l�9tr s:i: <br /> �, , TSDF TO GENERATOR <br />