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WEST CONTRA COSTA SANITARY LANDFILL <br /> WASTE INFORMATION FORM <br /> ONE COPY OF THIS FORM, ADDITIONAL SHEETS CONTAINING SUPPLEMENTAL <br /> INFORMATION AND WASTE REVIEW FEE SHOULD BE RETURNED TO: <br /> West Contra Costa Sanitary Landfill <br /> P. O. Box 5006 <br /> Richmond, CA 94805 <br /> 1. Generator Name: C k e j ran UL S- - Sw c_ <br /> 2 . Generating Facility Name/Address: Ckeofo- Ser,g,', , <br /> SO•-t...�+� Ce it Sf-�tQ-F- S-f�kl� -. �•'� <br /> 3 . Contracting Company: <br /> •pro; <br /> Name: Ofee, L •��1, +.. Pry Title: sA L&%.-q e , Phone: 6�5- 925d <br /> 4 . Waste Name: <br /> 5. Anticipated Volume: -i #0 r �3 Period. <br /> (Per day, one-time, etc. ) <br /> 6. Transportation Firm: _ Se 'Golj_ <br /> 7 . Type of Transport Truck: 10 Cy [ ] Semi-end [ ] Double bottoms [ ] <br /> Single bottom [ ] Drop box [ ] Individual Containers [ ) uKt.n.kA)0.. k( f4r"% i-" <br /> For WCCSL Use Only <br /> (Circle One) <br /> Form: Partial Complete Satisfactory: Yes No <br /> Compatibility: Compatible Incompatible Potentially Incompatible <br /> Reviewer: Date: <br /> Comments <br /> ACCEPT REJECT Authorized By: Date: <br /> Rates and Fees Quoted: Disposal Fee $ County/State Fee $ <br /> Special Handling: Burial Fee $ Push Off Service $ <br /> Method of Payment: Charge to Account <br /> Cash Check Purchase Order <br /> 1 <br />