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<br />!I FOi ASD., XNG`jJNON HAZARDOUS:WASTE�DRIVER.-IDENTIFICATION-FOR11J� =,L "+
<br /> f/t J
<br /> 021-14
<br /> Phone ( 2o9 ) r 94F3 x 5500 ' Contact PRES FY -3krili AR
<br /> ....._ ..'�_: t�rr, �w"'.'P*�'%,Js `.is=r.i'E�!i�„y.,. I• , 4 sF
<br /> Transporter. Y> •+ �_
<br />'Address 1` P A I I L I N F AV
<br /> j
<br /> Phone: ( 2-09 ,? .578 '' 49 00 SCOT4 _—
<br /> _- Contact:
<br /> rr .
<br />'I hereby certrfy-that the above named material•was picked up'at the generator site listed above
<br /> fJ :J r
<br /> Driver Signature:
<br /> hipment Date: — '2•
<br /> Truck No.: -- � `:' Load No.: Q _�
<br />`Vehicle License No.iState ����21 -1-40 /CA
<br /> aultant/Contractor.7W H SEMCDy
<br /> Address:— p .C . QX `. AD D-ES'TQ, ' Ch 05. .5` -:
<br />(Phone: ( 209 } ._�57 Contact:' _ MIKF KLQVI=ROAH/
<br />`I hereby certify that the above named material is consistent with the informatics presented in the Waste Characterization Form
<br /> and Contaminated Soil Description Form,rand has been properly described, classified and packaged,and is in proper condition--
<br />■■f or transport acdord' ,g to applicable regulations.
<br /> ame: :. Date:
<br /> $ �
<br />�7estinatiom Forward; Iver
<br /> 5
<br /> 9999 South Austrn Raad, anteca, California 95336
<br /> (209)-982-x298
<br /> Received}by
<br /> ' rDate r ,
<br /> r
<br /> » � s,..-sc t'nw L•t+i v,.n + � � r JL ...h � is
<br />�cceptanco'Na' " "�5�g2 225 4 Yzss c
<br /> '1'• { •+ .5� +�'y�.t��s_1 I���w.ik. �•r '_�� � ' f r as r-- -' �' +-,... 3 i- r 4 i '-�.
<br /> This load contains
<br /> ,� tiv. r 'i'iy x;,•se. w r v r„ ',, -, r +
<br /> -_ e n
<br /> Jar ''- -
<br /> TM less than''100 ob.m greater than 100 pprr,
<br /> - �� 'a''i0f4`rsC" fr,,r y.4i��'�v's7acr.3'•l�`i�, '�.'J - ,! S + r i z s.L.- � S _ -
<br /> sar h-r'rl�",' ' 4x K Y d�R•-:a`,�gfiTr.f" s s 1- + -� r L '
<br /> :, +, 'p' - _;S-f',4 a� Y�: ♦ -Pc
<br /> PY OF.•THIS SHEET MUST ACCOMPANY'EVERY VVASTE LOAD AND' MUST BE SUfBMITTED AT..THE GATF-P
<br /> OR.c:_
<br />[�W, FY ALL LOADS MUST BE SCHEDULEDAT'L''EA5T.24.} OUR IN AQVANCE:' {209)982-4298 'LANDFiI L.DELiVERIES`
<br /> MUST BE SCHEDUCtbD N A DAILY BASIS'ANY-UNISCHEDULED'LOADS MAY BE REFUSED'ATl,T'HE GATE:
<br /> ' z•r rj.dy,�t�y •r ,y ?. .74
<br /> ✓ �•'A '' ! q,i, "e'}"'�sUit-� �Y3..•Fr'''�,J,r°k1.z 4s;.' r} + 5. sF.+ t ° '1•' /! �,f.fiJ4 Se r�� ,r r"
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<br /> Mards Perth-is Load �'z
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