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NON-HAZARDOVS, 'Waste Hauler Document Daily Field Ticket No. 4104 4!"35 9 <br /> GENERATOR DESIGNATE .ITSD FACILITY . 4 ALTERNATE TDS FACILITY <br /> �i <br /> Name: S (LName: Name: <br /> EPA# EPA# EPA# <br /> Address: 3S g'n( Address: tr2. ? Vd Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUDGASWELL .. TER - 0THER 04eP, <br /> Wei bb�s= <br /> � Units C <br /> Weight/Volume gontainer: ❑ - Dump Truck - Tank Truck <br /> This material is nonhazardous because' <br /> 1)it is a drilling mud containing only the additivetdiium <br /> ted by the Departmentjn its exemption <br /> letter and contains no significant concentrationsoxic materials from nattirel sdurces,or <br /> 2)is a sulfur-dioxide scrubbier solution from.a s hydroxise c 'rsod <br /> lum carbonate oil <br /> field boiler scrubber system, and possesses no characteristics that would require its "x SIGNATURE OF AUTHORIZED AGENT. DATE <br /> handling as a hazardous waste. <br /> 71 <br /> . a z <br /> I` TR` PORTER 1 <br /> Warre. E. Gomes Exc., Inc. Job No. �� ^� "'� <br /> Pick-Up Date � <br /> P. O. Box 369 <br /> Rio Vistas CA 94571 Unit No. 3 <br /> (707) 374 28$1 SIGNATURE OF BUYER <br /> EPA#CAD"S 370 <br /> TSD FACILITYMethod of Disposal: <br /> ;4 <br /> Name ,'" " ❑ - Injection Well <br /> QTY Measured 50 « ❑ - Landfill - <br /> '' ❑ - Land Treatment <br /> EPA# <br /> 0,- 813L ❑`=-TONS OTHER ❑ - Surfaceundment <br /> Other <br /> r _ F�1 v <br /> SIGNAT .r'F A HORIZED ENT DATE J A <br /> TSDF TO GENERATOR <br />