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KUL) T Dk JINLI, nVl,. Q Q 1 <br /> INDUSTRIAL WASTE DISPOSAL 78588 ;1 <br /> 2650 W.HATCH ROAD ]{{ <br /> PHONE MODESTO,CALIF. 95358 1 d� <br /> 538-1430 W/Tg I <br /> DATE ..: CUSTAco <br /> .?,� <br /> CUSTOMER,; <br /> O <br /> ADDRESS f',rli CALIF. N <br /> DRIVER,' TRUCK NO. ('i7 <br /> d <br /> BIN TO BE REPLACEDYES 0 NO❑ <br /> COMM TY <br /> WEIGHT CU. YQS <br /> METAL <br /> APER p� <br /> CANS,USED <br /> CONCRETE OR DIRT <br /> CANNED GOODS <br /> WASTE WET <br /> TRASH <br /> COMPACTED TRASH I <br /> COMPACTED PAPER <br /> WOOD I <br /> `I <br /> SPECIAL BURIAL j <br /> CUSTOMER'S <br /> SIGNATURE X I <br /> .j:uslame cknowkdges<o la nn osrece rad in good wnd tion and ogrcn(11 to mmnbin it m 7 <br /> d and tory o dor and w d l ,121 to p ods din and mm onFy m con omen p�vided loi •Q <br /> I am, <br /> sp«,hc propose,101 nol b load n encau of 40,000 lbs in ony conmmer and agrees la pay all Il <br /> cntro fees and domoges caused by wnd overloodi,,gg jdI b roimbune oolledor for any dvmage to <br /> container e¢Ivding mawnabe wwr and Isar and damoga caused by coletlor or ds amyb�eos, j5) <br /> to indemnify and hold collecbr harmins hem any claim 6,injury to a Third pony,and(6 to pay .I <br /> reownable anamc,fees and ousts Inr any action r gmred in connection with this ogmemmtl. <br /> DO NOF WRRE BELOW THIS UNE <br /> -Cu.YDS. vI <br /> CU.YDS. <br /> U) <br />