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i _ <br /> r <br /> NON-HAZARDOUSWaste auler b Cl1 ent Dail Field Ticket No. qt <br /> Daily 45490 <br /> GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: — Name: <br /> J/ Stt 47 <br /> Name: <br /> EPA# EPA# <br /> EPA# <br /> Address: Address: 1105 Address: <br /> 1 <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ASWELL WATER - OTHER <br /> Weight/Volume 12a.. 47.E Units �<an <br /> Container: ❑ - Dump Truck �I- 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 from.a sodium hydroxise or sodium carbonate oil <br /> field boiler scrubber system, and possesses no characteristics that would require its <br /> handling as a hazardous waste. SIGNATURE OF AUTHORIZED AGENT DATE <br /> f <br /> TRANSPORTER 12 <br /> Warren E. Gomes Exc., Inc. Job No. J-) <br /> P. O. Box 369 Pick-Up Date <br /> Rio Vista, CA 94571 .22 %. to/ <br /> (707) 374-2881 2 <br /> Unit No. <br /> EPA#CAD076557370 SI AT OYER <br /> TSD FACILITY <br /> _ Method of Disposal: <br /> Name_ QTY Measured °_ Injection Well <br /> Landfill <br /> EPA# ❑' .and Treatment <br /> :-$BL ❑ - TOMS ❑ - OTHER © rface+m�ypTdment <br /> -,e=Okter l , <br /> SIGNATURE OF /Z_ <br /> UTH RIZED AGE - <br /> DATE <br /> TSDF TO GENERATOR <br />