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NON-HAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR CUSTOMER <br /> Name: SJ Countv Courthouse Name: :I Doulos Environmental Inc. <br /> Address: 222 E. Weber Avenue Address: ! P. O..Box 2559 <br /> Stockton, CA 6 Oran evale CA <br /> f Phone: (775) 851-7240 Phone: !916-990-0333 <br /> �i <br /> DESCRIPTION <br /> Description of Water : Purge water from Monitoring Wells <br /> Volume/Wei ht: i`2 <br /> Volume/Weight: Units: gallons Container(s): Poly Tank <br /> This non-hazardous waste water is monitoring well purge water,auger rinsate,sampling equipment rinsate,tank_ rinsate,combination thereof,or as described above.Described water may contain dissolved hydrocarbons. I certify that <br /> the above named material has been properly described and classified according to applicable regulations,and possesses <br /> no,characteristics hat would require its handling as hazardous waste. <br /> L <br /> Generator/Authorized Agent: Hal Hansen <br /> Print lgn i Date <br /> TRANSPORTER <br /> Name: Doulos Environmental Job No: NA <br /> Address: P. O. Box 2559 Pick-up Date: i 1 <br /> Orangevale, CA 95662 Truck 1D: NA <br /> i <br /> Phone: 916-990-0333 Driver:_<_% C-r :.�, � C( -( t <br /> Sign Date <br /> I <br /> DISPOSAL FACILITY <br /> Name: InStrat Inc. Quantity: <br /> Address: P. O. Box 2279 _! Units: gallons _ <br /> f Davis, CA Disposal Method: <br /> Received by: <br /> Print Sign Date <br /> L <br /> � l <br />