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Treated Wood Waste Disposal Form
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Load Information
Number Number Number
Date Delivered
Estimated percentage (by weight) of treated wood waste in load
Driver Information
Driver Name
Driver Phone Number
Driver's License Number
Vehicle License Plate Number
Transporter
EPA Number (If applicable)
Transporter Company Name
Transporter Contact Name
Company Address
Phone Number
City / State
Zip Code
Generator
EPA Number (If applicable)
Generator Name / Generator Company Name
Generator Contact Name
Generator Address
Phone Number
City / State
Zip Code (copy)
Submit
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