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® Recycled Paper <br /> • r�OR NON- <br /> HAZARDOUS INC, NON HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> 03043 <br /> Generator LAS. � <br /> Address <br /> Phone 941— _ 13-72;- Contact <br /> 1 <br /> Transporter µ• P <br /> s_ } <br /> Address PCd7, &-t _--y�' � [, - -5 F <br /> Contact 1 <br /> Phone (�f{(�.) _ v C4z--v t fir' <br /> I hereby certify that the ap6 a/named mate it a[ 9i CTed up at the generator site listed above <br /> i f <br /> Driver Signature <br />' Shipment Date <br /> qr <br /> Truck No f d Load No .. <br />' Vehicle License No/State -11 <br /> t ha> 4=t'a I g,--Tj <br /> 19 sultant/Contractor os <br /> Address <br />' Phone Contact _ <br /> I hereby certify that the above named material is consistent with the information presented in the Waste Characterization Form <br />' and Conta natedSoil Description Form,and has been properly described,classified and packaged,and is In proper condition <br /> for transpprt ccordin applicab[ gulat ami s q <br /> Name Date }'7� <br />' Destination Forward, Inc <br /> 9999 South Austin Road, anteca, California 95336 <br /> (209) 982-4298 <br /> Received by / <br /> Date -- <br /> Acceptance No — '9-)- _ _1 -74 <br /> This load contains soil with <br /> less than 100 ppm greater than 100 ppm <br /> )PY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE FOR <br /> i RY ALL LOADS MUST BE SCHEDULED AAEAST 24 HOURS IN ADVANCE (209)982-4298 LANDFILL DELIVERIES <br /> MUST BE SCHEDULED ON ACD�AILY BASIS ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE <br /> Yards Per this Load L3 - <br /> TRANSPORTER COPY <br />