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T—— - Recycled Paper v T <br /> LFR�Wi R IDENTIFICATION FORM <br /> �FOARD, I4C. , NON-HAZARDOUS WASTE DRIVE <br /> 51E <br /> Generator _ A A <br /> JE <br /> Address <br /> Phone (Z09) �— - j Contact <br /> Transporter <br /> Address r <br /> Phone Z , ) - - I'�2 contact <br /> I hereby certify that the apo4 nam e¢ material was picked p at the generator site listed above <br /> Driver Signature -- <br /> Shipmert Date <br /> Truck No Load No <br /> Vehicle License No /State <br /> r- <br /> Onsuktan#/Contractor T <br /> ddress <br /> f <br /> )p jt2 4A <br />, Phone (o -2-5-L— - Contact <br /> I hereby certify that the above named material is consistent with the information presented in the`baste Characterization For <br /> pery described,classified and packaged,and is in proper conditic <br /> and Contaminated Sail Description Form,and has been pro <br /> for transport according to applicable regulations <br /> Date <br /> Name <br /> Destination Forward, Inc <br /> 9999 South Austin Road, Manteca, California 95335 <br /> (209) 982-4298 <br /> Received by <br /> Harp <br /> Acceptance No 7 9I— - <br /> This load contains soil with <br /> less than 100 ppm greater than 100 pp <br /> EW <br /> OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE FG <br /> t= TRY ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS'N A DAILY BASS ANY UNSCHEDULED MAY BE ADVANCE REFUSED 09)982-4298 LANDFILL ELIVERIE <br /> MUST BE SCHEDULED O REFUSED AT THE GATE <br /> Yards Per this Load <br /> iWHITE-FACILITY COPY YELLOW-TRANSPORTER COPY PINK-GENERATOR COPY <br />