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, .NON-HAZARDOUS Waste Hauler DocumentDaily Field Ticket No. 45167 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: <br /> Name: Name: <br /> EPA# EPA# EPA# <br /> Address: -11 ,,✓ Address: Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WAkrER OTHER <br /> Weight/Volume Units 4i 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 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 as a hazardous waste. <br /> TRANSPORTER r <br /> Warren E. Gomes Exc., Inc. Job No. Pick-Up Date <br /> P. O. Box 369 <br /> Rio Vista, CA 94571 Unit No. _f to 2- <br /> (707)(107) <br /> 374-28$1 NATURE OF BUYER <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Injection Well <br /> Name QTY Measured ( � ❑ - Landfill <br /> ❑ - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS ,L;-- OTHER ❑ Surface ITRdment <br /> Q-'- Other <br /> SIGNATURE OF AUTHORIZED A NT DATE <br /> TSDF TO GENERATOR <br />