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INION-HAZARD aSt@ Hauler Document Daily Field Ticket No. H 103745589 <br /> GENERATOR? DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name,L Name: JAName: <br /> EPA# EPA# EPA# <br /> Address ^t Addig <br /> ress: Address: <br /> Order Placed: Order Date: <br /> WASTE `°O - DRILLING MUD $' tl:- GASWELL WATER - OTHER <br /> "" Weight/Volume 15 Units Container: 0 - Dump Truck - Tank Truck <br /> f4material is nonhazardous because: <br /> 1)At is a drilling mud containing only the additives listed by the Department in its exemption <br /> tetter and contains no significant concentrations of toxic materials from natural sources,or <br /> �1) is a sulfur-dioxide scrubber solution froma 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"es a hazardous waste. <br /> TRANSPORTER <br /> `Warren E. Gomes Exc., Inc. Job No. X60 < e Pick-Up Date <br /> Box 369 <br /> Rio Vista, CA 94571 Unit No. <br /> (707) .374 SIGNATURE OF BUYER — <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> �= ❑ - injection Well <br /> Name QTY Measured ❑ -Landfill d, <br /> ❑ - Land Treatment <br /> # ❑ - BBL ❑ - TONS , OTHER ❑ - Surface ImpoTyent <br /> Other <br /> 0 <br /> -e <br /> SIGNA REEF AUTHORIZED AGENT 'DATE <br /> TSDF TO GENERATOR <br />