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'NON-HAZARDOUS WasteHauler Document¢Daily Field Ticket No. 45169 <br /> l <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> ,fes„ <br /> Name: J/4� Name: alo Name: <br /> EPA# EPA# <br /> p EPA# <br /> Address: ' 1� Address: <br /> Address: <br /> NEW <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WT R 5?- OTHER <br /> Weight/Volume Units Container: ❑ - DumpTruck <br /> - 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 <br /> Warren E. Gomes Exc., Inc. Job No. "f Pick-Up Date. ,) <br /> P. O. Box 369 <br /> Rio Vista, CA 94571 Unit No. ..../ <br /> (707) 374-2881 IGNATURE OF BUYER <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> - Injection Well <br /> Name OTY Measured ❑ - Landfill <br /> o - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS OC -'OTHER ® - Surface Imp�tp�.ment <br /> .. '- Other ``���`- <br /> SIGNATURE OF AUTHORI D AGENT GATE <br /> TSDF TO GENERATOR <br />