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ALTAMONT LANDFILL <br /> WASTE E ACCEP 1 ANCE FORM <br /> CUSTOIvMR NAME-. LAA-EM- 4CE LIVEnIORE NATIONAL LABORATORY <br /> CUSTOMER�i -0047 ^' 13 <br /> TRIP TICKET NO. <br /> ATERL,kL DESCRIPTION- GLASS ASS III CO`TR SOIL TRUCK vol. <br /> - M <br /> PROFILE r-408124--yP15:Kh�;-D1U1_Sp4;, .16 <br /> sri tzr No. vol. � <br /> WASTE SOL'RCE (Counry -;ity location) - LIVERMORE <br /> • The Information listed above is necessary for acceptance of special waste at tho <br /> Altamont Landfall. <br /> • A copy of this form must be presented with tacb lnad to the Altamont scale house <br /> collector. <br /> • This form is for Altamont waste tracking '®se and is not intended to serve as a <br /> customer shipping document. <br /> • Drivers will receive a weight ticket for confirmation of disposal <br /> • An :alternative shipping record may be used in lieu of this form if it includes the <br /> above information. <br /> • If shipping form Ls a multiple part form, please notify landfill of which copies to <br /> return with the driver. if not otherwise noted on the form- <br /> FOR ALTAMON."T COLLECTOR USE ONLY: <br /> FILL Iti TAG# ASSOCLA IED `N11-H LOAD (USE OUTEOL'ND4 FOR LST.'RED LOADED <br /> SCALE HOUSE TAG 4 - 0 1 3 — <br /> DATE <br /> TRUCK m � / <br />