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1 <br /> 1 <br /> 1 <br /> Generator Information <br /> Name Five Marine <br /> r Address <br /> Description of water Non-Haz purge water UST Sites <br /> Non-Hazardous waste water monitoring well purge water and/or auger rmsate,tank ansate or above described water This water may <br /> contain dissolved hydrocarbons 1 certify that the above named material is a liquid exempt from rcra per 40 efr261 4(b)(10)and does <br /> ' not meet the critena of hazardous waste as described in 22 ecr article I I or any other applicable state law Has been properly <br /> described Classified and packaged and is in proper condition for transportation according to applicable regulations <br /> Generator/Authorized agent <br /> ' Print sign date <br /> Transporter Information <br /> ' Company name American Valle Waste <br /> Valley O>_1 <br /> rTruck Id Dnver �,' , - <br /> Print sign date <br /> ' • Total Gallons <br /> I-actlity1iF6n-ria.l](3f1 <br /> -arcade �rencral l Flu /\ppr v,1 I � l � bcr f(0_) <br /> 2 I <br /> 5555 N (`hanncl <br /> Portland, OR 97?1 I <br /> GRD 18761934 <br /> ' Via Railcar #t <br /> Rccc i vcd by <br /> Prwt full liarrif, and 5lgll <br /> r <br /> r <br /> r <br /> r <br /> • <br /> r <br />