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SOUTH AUSTIN ROAD,MANTECA,CA 15136 + VIOST OFFICE IIOX SM.1TOCKTON,CA 15206 x r �• w �•w'�,1' <br /> VAIN OFFICE (209)X66-51112 LANDFILL (209)0424228 RESOURCE RECOVERY.(209)OB24M +AX 4200)W2.16 5` <br /> r_ ❑ RESOURCE RECOVERY , <br /> �TRULANDFILL CKNO x �- -� Fri. s:� ., , _ AT1ON FORM <br />' TRAILER NO DATE r f 79y 'f 00934 <br /> 'BILL TO cy <br /> r� , - <br /> t/"14, <br /> �•,�• QUANTITY SIZE YDS DESCRIPTION =PER YD 4 AMOUNT^ <br /> D DROP BOX _ e <br /> 11 COMPACTOR — - - .k ;.Y <br /> ❑ FRONT LOADER <br /> s <br /> ❑ DEMOLITION ��► 1 i r 3 ' I <br />' ❑ASBESTOS — <br /> ❑ ASH <br /> GONTAWNrE 0 <br /> LEAN 501 ri1rLkV.A <br /> ❑ OTHER <br /> "TOTALNIN <br /> ► $'� r % ,. .� « �N r� a[,f u.t-� wti�e. c. <br /> Signed rL --�_ - T �„OUT t'-�� -rte ►M IPM <br /> Truck No Load No <br /> Vehicle License No /State <br /> Consultant/Contractor <br />' Address 7 'L' ' <br /> Phone <br /> Contact 2l �r= " 6-1 <br />' 1 hereby certify that the above named material is consistent with the information presented In the Waste Characterization Forn <br /> and Contaminated Soil Description Form,and has been properly described,classified and packaged,and is in proper condition <br /> for transport according to app, le regulations <br /> Name - err �` 1 Date ! 7" -Z <br /> Destination Forward, Inc <br />' 9999 South Austin Road, Manteca, California 95336 <br /> (209) 982-4298 <br /> Received by ' 0 �! <br /> DateC-4 _ <br /> Acceptance No - <br />' This load contains soil with <br /> less than 100 ppm greater than 100 ppr <br /> A COPY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD,AND MUST BE SUBMITTED AT THE GATE FOI <br /> ENTRY ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS IN ADVANCE (209)982-4298 LANDFILL DELIVERIE: <br />' MUST BE SCHEDULED ON A DAILY BASIS ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE <br /> Yards Per this Load <br />