Laserfiche WebLink
s � 1St@ > <br /> auler Document Daily Field Ticket No. / 45173 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: Name: VAV_�* <br /> Name: <br /> EPA# EPA# EPA# <br /> Address: Address: ^� Address: <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER.._ OTHER e <br /> Weight/Volume JZ! Units 5 Container: ❑ - Dump Truck 1 = Tank Truck <br /> Tttis material is nonhazardous because: <br /> «,l')it is a drilling mud containing only the additives listed by the Department in its exemption - <br /> f+ir find contains no significant concentrations of toxic materials from natural sources,or <br /> ).:is asulfur-dioxide scrubber solution froma sodium hydroxise or sodium carbonate oil <br /> field boller scrubber system, and possesses no characteristics that would require its SIGNATURE OF AUTHORIZED AGENT <br /> handling as a hazardous waste. DATE <br /> TRANSPORTER <br /> Warren E. Gomes Exc., Inc. Job No. !� Pick-Up Date <br /> P. O. Box 369 <br /> Rio Vista, CA 94571 Unit No. <br /> (707) 374-28$1 SIGNATURE OF BUYER <br /> EPA#CAD076557370 <br /> i <br /> TSD FACILITY Method of Disposal: <br /> Name QTY Measured ° - Injection Well <br /> - Landfill <br /> G Land Treatment <br /> EPA# 0 - BBL ❑ - TONS ❑ - OTHER ° -Surface 1ment <br /> �- Other Td <br /> SIGNATURE OF AU j-ORI, AGENT DATE <br /> TSDF TO GENERATOR <br />