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i <br /> .. <br /> ' I <br /> generator: PIS <br /> address: 0G,-�VJ ; <br />'hone: (��(A }�� - C100.3C100.3Contact: !�` <br /> ,f <br />"ran sporter: Te-11VI 0 aw <br />%ddress: <br />'hone: {`6p�j � - Contact: ✓ :. <br /> hereby certify that the ab ve amed mate ial was picked up at the generator site listed above. <br /> 4 <br />)river Signature: <br /> 1 .001- <br /> -hipment Date: <br /> 2— <br /> ruck No.: C 41 Load No.: ' <br /> P!s� �d� " <br /> 'ehicie License NoJState:— � x ,_ <br /> ;j tant/Contractor: V• e v <br /> NIM rd ess: ..:.:a.I <br /> o o S US f VI La LA Ir � <br /> ,h.one: { j - _ --Contact: <br /> hereby certify that the above named material•is consistent will,.the information presented in the Waste Character z Form � <br /> nd Contaminated-Soil Description Form,and_has been properly described classif ed and packaged,andas n pyo e o clition <br /> �r transport a `'ording to applicable reguCations. <br /> Laine: Date. <br /> )estimation: Forward, Inc. m "•{ <br /> 9999 South Austin Road, Manteca, California 95336 <br /> (209) 982-4298 i z <br /> Received by: <br /> Date. 2 <br /> ,cceptance No.: - �-•� <br /> 'his load contains soil with: <br /> less than 1©0 ppm <br /> PY O�THIS SHE7=T MUSTS CCO AS ' <br /> AL --0 DS MUS B C E®ULED L ` 'S D 20 • <br /> US B SC �D LD ® A DAIL 51S AN U S :* 17 <br /> r•s 'e s oa <br />