Laserfiche WebLink
1 <br /> PROFILE NO. Q0 <br /> WEST CONTRA COSTA SANITARY LANDFILL <br /> WASTE DISPOSAL REQUESTIINFORMATION FORM <br /> 1. GENERATING FACILITY NAME/ADDRESS: C kc j ro ^ S . A , -T,,,-,- <br /> 2. <br /> T,,,-c2. CONSULTANT ('rf any) <br /> Name: G( e-e% L • M,f c,a,e t I Telephone:t y i S) COB 5 `{Z J <br /> 3. WASTE NAME: <br /> 4. ANTICIPATED VOLUME:w200 e--43 (q6-DEEUVERY PERIOD: 1 J.::y <br /> -4-az. -Ie L •SJCD4r. 70 *sk0'/—+er day, week, one-time only) <br /> 5. TRANSPORTATION IIRM: 14 <br /> �ff C�ti CjGt4 <br /> 6. TYPE OF TRANSPORT TRUCK: 10 CY � Semi-end Double bottoms <br /> Single bottom EjDrop box 13 Individual Containers 10 <br /> 7. METHOD OF PAYMENT: Check ED Cash B Charge X Purchase Order E] <br /> . (Charge & PO must have prior WCCSL. Accounting Department approval) <br /> Charge Account Name Gru--.o 9..-&,+I- Purchase Order No. <br /> T C.".Isr../ <br /> 8. Description of Process and Circumstances Producing Waste: / <br /> 5 c i i• 4,-, <br /> For WCCSL Use Only <br /> FORM. ACCEPT: REJECT: Notification: a Y V <br /> Partial [a Complete� Authorized By: t4l��� Expiration: �✓l D <br /> Compatibility: Date: ���Zf r L� Appointment: <br /> Compatible <br /> Incompatible RATES AND FEES: <br /> Potentially Incompatible <br /> Disposal Rate: <br /> r� <br /> ND: Yes No <br /> DE <br /> ` �/ � / County/State Foes: <br /> Reviewed by: T el <br /> Date: Other Rates/Fees: <br /> iWwaste.rev xaraa,.�r4 �s.� �+•'��^'•� 1 of 4 Rev.4/90 <br /> .Sane scft <br />