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Recycled Paper <br /> FpRVIiAR3;INC. NON-HAZARDOUS 1NASTE DRIVER IDEh1TIFICATION FORM <br /> _ t <br /> a <br /> 515 <br /> Generator <br /> E Address �A <br /> Phone (205 ) '17F .- - -5 Z= Contact <br /> E <br /> Transporter —TZ / <br /> Address <br /> Phone q9n t <br /> /h <br /> I hereby certify that the above name material was pi ed up at the generator site listed above <br /> Driver Signature <br /> Shipment Date <br /> rTruck NoLoad No <br /> Vehicle License No/State L <br /> 1 <br /> IWnsultant/Contractor G LjA? <br /> Address G 737 A) 14 k� <br /> Phone (zr-f7 ) 2S7 - d 7" Contact <br /> I hereby certify that the above named material is consistent with the information presented in the Waste Characterization Fc <br /> and Contaminated SoiMescription Form,and has been properly described,classified and packaged,and is in proper conditi <br /> for transport accpf�kng to applicable re ulations - <br /> Name ,�� Date <br /> 1 <br /> Destination Forward, Inc <br />' 9999 South Austin Road, Manteca, California 95336 <br /> (209) 982-4298 J <br /> Received by <br /> Date <br /> Acceptance No 7- 3 3 - _ 3 - <br /> This load contains soil with <br /> less than 100 ppm greater than 100 pF <br /> COPY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE F( <br /> NTRY ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS IN ADVANCE (209)982-4298 LANDFILL DELIVERI, <br /> MUST BE SCHEDULED ON A DAILY BASIS ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE <br /> Yards Per this Load .— I/ — <br /> WHr E-FACILITY COPY YELLOW-TRANSPORTER COPY PINK-GENERATOR COPY <br />