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J` <br /> NOWHAZARDOUS Wasteauler Document Daily Field Ticket No. q` 45488 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: Name: !q)114 <br /> Name: <br /> EPA# EPA# <br /> EPA# <br /> Address: Address:-)10 ,5 0tf� � Address: <br /> ire�s� .� � � s <br /> Order Placed: Order Date: <br /> WASTE 0 - DRILLING MUD ,.,�ell <br /> SWELL WATER - OTHER <br /> &rq <br /> Weight/Volume l Units Container: 0 Dump Truck Er- 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 /> is.a sulfur-dioxide scrubber solution from.a 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 o� f t� J <br /> Warren E. Gomes Exc., Inc. Job No.23 G 0 e t(ine + / Pick-Up a <br /> P. O. Box 369 —7 <br /> Rio Vista, CA 94571 Unit No. <br /> {707) 374-281 NATURE OF BUYER <br /> EPA#CAD0765 `370 <br /> TSD FA ITY Method of Disposal: <br /> ❑ - Injection Well <br /> Name - QTY Measured 137 Landfill <br /> ❑ Land Treatment <br /> EPA# ❑ - BSL ❑ - TONS ❑ - OTHER ❑ - Surface Igtrment <br /> _ „,Q-=Other <br /> SIGNATURE OF A HORIZED AGE DATE <br /> TSDF TO GENERATOR <br />