Laserfiche WebLink
_ r <br /> 4 <br /> Vli1] = �, AZAR1S �l' �O NTIFiCi4 "1� 1 <br /> enerator: <br /> dress: <br /> 1532Rt-p ad VOG <br /> lone: { W y0ar s ' Contact: <br /> -ansporter: Te Y V, (•a . - <br /> Jdress: (.v f ./YG1 dCt1 s A <br /> none: (gp�j __ - Contact: <br /> iereby certify that the abnamed material was picked up at the generator site listed above. <br /> 7,- <br /> fiver Signature- 299 <br /> � <br /> iipment D te: 7-,/ _- _ <br /> uck No.- -G�11....._...-,, Load No.: s- FOUL <br /> 3hicle License.No./State:_-z' <br /> eo{ ctr ✓iUy <br /> ti <br /> y, y -nt/Contractor: — - - -- <br /> Iess2 <br /> ?we: 2_ - qQ 3 Contact: PO sC,yt)::'a. r cA4�1 � <br /> ,areby certify that tha above named material is consistent with the information presented in the Waste Characterization form , <br /> ►d Contaminated Soil Description Form,and has been properly described,classified and packaged,and is in preper�co dation 1 <br /> rtransporl ac n to applicable regulations. <br /> 3me: Date: <br /> .: <br /> ` i <br /> i <br /> -3stination: Forward, Inc. <br /> 9999 South Austin Road, Mahteca, California 95336 <br /> (209) 982-4298 <br /> Received by: <br /> Date: ; <br /> d <br /> :ceptance No.: <br /> its load contains soil with: <br /> less than 100 ppm ce te' t a f 00 k~ <br /> a <br /> - <br /> Y OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOA:D., D STB S B ITT =D G D <br /> I-OM <br /> �ADS UST, ESC ' EDU L E._D AT LSAST> 4 OURS aD ' C ( D9 9 9 I D <br /> STB C EDUL�ED`O� iDA11v <br /> BASL$._ ANY UNSC EDIJED Q S S <br /> � •s 'e s a• ' .�.. <br />