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RECYCLING Pickup Date on card <br /> 162 5.Aurora 51.Stockton,O 95202 <br /> (209)463-7600 Fm(209)4n7600 j- <br /> CEw#106129 CnvuaCIWI TCP or'TriValley: (Circle One) <br /> MUNN <br /> •Company Name: <br /> Office Hours <br /> •Contact Name: - %;, y Ready for pick up <br /> es ❑ No <br /> *Address: � �< _� � " Floor Spite# <br /> ILI <br /> A <br /> Clry t ' i Code—, r . Route# <br /> Phone: i - + - First time <br /> Fax: i r i Z.'t "t i a '3 eS ❑ No <br /> %i <br /> Notes/Special <br /> Instructions <br /> Items A roximate uanti Actual muni <br /> CRT Televisions/CRT Monitors: Wei ht lbs) <br /> 65= " <br /> LCD/Plasma Televisions <br /> Com uter Towers"-/ Comp­- <br /> Auto/Forklift <br /> om -Auto/Forklift Batteries <br /> E-Waste <br /> Other: CP Ba ,household items <br /> Co Machines $40 Charge) t <br /> PPP <br /> Total Wei <br /> ❑ Loading Dock ❑Forklift o TV over 271' <br /> ❑Palletizedo Double stack if less <br /> ❑How High Palletized_ than 5" <br /> Please Check item ❑ Shrink Wrap Needed? ❑Pallets Needed ❑ Gaylord Boxes <br /> listNeeded?_st before pick up ❑Hand Truck <br /> process ❑Dolly Needed C3 Pallet Jack Needed? <br /> (State Y/N) <br /> o Needed. <br /> Need Helper_ ❑Number of Locations ❑Address/Map <br /> o School ❑ Campus Map o Security <br /> Clearance <br /> o Charge Customer$_ ❑Pay Customer$ ❑ Form 197 <br /> (collectorr)) <br /> o Certificate of Destruction <br /> L <br /> Customer Signature: <br />