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NON-HAZARDOUS Waste Hauler Document Daily Field Ticket No 87114 <br />GENERATOR DESIGNATED TSD FACILITY ALTERNATE TDS FACILITY <br />Name: Name: Name. <br />EPA # EPA # EPA # <br />Address. Address: Address' <br />Order Placed Order Date: <br />WASTE - DRILLING MUD LI - GASWELL WATER LI - OTHER <br />Weight/Volume Units Container: 0 - Dump Truck 0 - Tank Truck <br />This material is nonhazardous because. <br />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 />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 SIGNATURE OF AUTHORIZED AGENT DATE <br />handling as a hazardous waste <br />TRANSPORTER <br />Warren E. Gomes Exc., Inc. Job No Pick-Up Date <br />P. 0. Box 369 <br />Rio Vista, CA 94571 Unit No <br />(707) 374-2881 SIGNATURE OF BUYER <br />EPA # CAD076557370 <br />TSD FACILITY <br /> <br />Method of Disposal: <br />- Injection Well <br /> QTY Measured 0 - Landfill <br />- Land Treatment <br />- BBL 0 - TONS 0 - OTHER 0 - Surface Impoundment <br />- Other <br />Name <br />EPA n <br /> <br />SIGNATURE OF AUTHORIZED AGENT DATE <br />GENERATOR COPY