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N <br /> '11111ON-HAZARDOUS Waste Hauler Document Daily Field Ticket No. . 45489 <br /> GENERATOR DESIGNATED''TSD FACILITY ALTERNATE TDS FACILITY <br /> Name: , o Name: Name: <br /> EPA'# EPA# EPA# <br /> f /� <br /> Address: Address: f 05— C r /`►/��r' RO Address: <br /> 6A. <br /> Order Placed: Order Date: <br /> WASTE ❑ - DRILLING MUD ❑ - GASWELL WATER -E(-~OTHER�_ <br /> Weight/Volume 12 P A Units Container: ❑ - DumpTruck <br /> Tank Truck <br /> This material isnonhazardous 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 /> 4a6 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 DATE <br /> handling as a hazardous waste. <br /> a � <br /> TRANSPORTER ,Ara <br /> Pick- <br /> Warren E. Gomes Exc., Inc. Job No. t®6 60r4P �`�� <br /> Up D to <br /> P O. Box 369 -^ / 0 t <br /> Rio Vista, CA 94571 Unit No. ZZ � <br /> (707) 374-2881 1SIGNATURE OF BUYER <br /> EPA#CAD076557370 <br /> , <br /> TSD FACILITY <br /> Method of Disposal: <br /> e`� ® - Injection Well <br /> Name QTY Measured ` �"'� ❑ - Landfill <br /> ❑ - Land Treatment <br /> EPA# ❑ - BBL ❑ - TONS ❑ - OTHER ❑ - Surface imp rent <br /> -" r ."Other <br /> . il <br /> -S -7 <br /> SIG TORE OFA ORIZ Bb AGENT DATE <br /> TSDF TO GENERATOR <br />