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NON-HAZARDOUS Waste Hauler t Daily Field Ticket No. �� 45487 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY'- <br /> secName: Name: Name: <br /> EPA# EPA# EPA# <br /> Address: Address:!d 4�—a f � � Address: <br /> lk <br /> / r� C <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ GASWELL WATER - OTHER S �� UA-it <br /> Weight/Volume Units Container: ❑ - Dump Truck 4?1- 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 <br /> handling as a hazardous waste. DATE <br /> TRANSPORTER 0 . <br /> Warren E. Gomes Exc., Inc. Job-No• 1/te ra'� Pick- D 7 r <br /> P. O. Box 369 � <br /> Rio Vista, CA 94571' Unit No. <br /> (707) 374-2881 SIGNATURE OF BUYER - <br /> EPA#CAD076557370 <br /> TSD FACILITY Method of Disposal: <br /> ❑ - Injection Well <br /> Name QTY Measured ❑ - Landfill <br /> 13 - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS OTHER o - Surfac"ccdment <br /> �- Other <br /> w 15// ,5 <br /> SIGNATURE OTHORIZE GENT DATE <br /> I <br /> TSDF TO GENERATOR <br />