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Recycted Paper <br /> - :. x � y <br /> s' `{ —HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> FORWARD, INC. NON <br /> 03076 <br /> INs—Lrn t. ift <br /> Generator: Bank 0� - Stockton Genera':-in, Loc;a-t ion : 04 s0 S _ Dorado <br /> P. D_ Cnx 1110 , `tCC!<t,'n , Ca . 95209 <br /> Address: <br /> Phone: { 2 0 941 _ 1 315 Contact: —John tJ r r u t i to <br /> Transporter: M P L'! 1 S`ryct^s ' r,c _ <br /> Address: .1-1&00 Manor S` - , Prtkersf 4 el 6 , C,� <br /> Phone: ( 91 IS 5 6 2 _ ^? 16 Contact: L-d Y' 0 r r <br /> hereby certify that thq ove named material was pick dr at the generator site listed above. <br /> Driver Signature: <br /> Shipment Date: <br /> 1 Truck No.: Load No.: <br /> Vehicle License No./State: `� <br /> au ItantlContractor: Rine Environmental <br /> Address: P. J. Box 200 Folsom. Ca _ 95620 <br /> Phone: ( 91 � 9B3 2241 Contact: Ronald IC_ Rinehart <br /> I hereby certify that the above named material is consistent with the information presented in the Waste Characterization Form <br /> and Contami ted Soil Descriptio',Form,andhas been properly described,classified and packaged,and is in proper condition <br /> for transport:,ac ordin�tc ,ia piicable a ulati �s. <br /> Name: Date: <br /> '7 <br /> �_ <br /> De jination: Forward, Inc. <br /> 9999 South Austin Roa , Manteca, Cialifornia 95336., <br /> (209).982-4�gg...., <br /> RecelY.e4,by: i <br /> r Date: r <br /> Acceptance No.: 1 7 1 <br /> -This load contains soil with: <br /> Vas anCl <br /> nie 1 f^nntamlbzd_rrl6ss than 100 ppm greater than 100 ppm <br /> 3 ]PY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE FOR <br /> i l=Tvr1 RY.ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS IN ADVANCE: (209)982.-4298 LANDFILL DELIVERIES <br /> MUST BE SCHEDULED ON A DAILY BASIS. ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE. <br /> r <br /> .Yards Per this Load: r;ate <br /> TRANSPORTER COPY _ <br />