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v 4 b <br /> AL F O LANDFILL <br /> WASTE ACCEPTANCE FORM <br /> CUSTOMER M AME. LAWF.Ei10E LIVERMORE NATIONAL. LALIOR.ATORY <br /> CUSTOMER 4i 0047o <br /> ' 'f <br /> �. � TRIP CICfi'T Nt ,. <br /> , . <br /> MATERL f'ESCRIPTION• GLASS III COVER SOIL ucx <br /> SP/RP <br /> PROFILE r-408124-AP16:86r-D1U1-CP9a.9 w qR. <br /> WASTE SOL"RCE i Counn- --'iry location) - L11,TMNIORE <br /> 9 <br /> • The information Listed above is necessary for acceptance of special waste at tho <br /> Altamont Landfill. <br /> • A copy of this form must be presented with ac load to the:Utamont scale house <br /> collector. <br /> • This form is for Altamont waste tracking !ise and is not intended to serve as a <br /> customer shipping document <br /> • Drivers will receive a weight ticket for confirmation of disposal. <br /> p <br /> • An alternative shipping record may be used in lieu of this form if it includes the <br /> above inform2otion. <br /> • If shipping form is 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 ALTAMONT COLLECTOR USE ONLY: <br /> FILL Iti TAGi$ a-SSOCLA TED ,`TI r1 LOAD (t-7SE oUTEOU T)4 FOR U-N-T.'.R.ED LOADS) <br /> SCALE HOUSE TAG - c)0 U <br /> DATE 6 <br /> TRUCK R __,__„- I <br />