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JUN-I9796 09: I6 FROM:ALTAMONT LANDFILL & RRF ID.- FACE 4/4 <br /> ATTAMONT LANDFILL <br /> r163.4 <br /> WASTE ACCEPTANCE FORM <br /> CUSTOMER NA.ME: LA CE LIVERMORE LAB TRIP TICKET NO. <br /> TRUCK VOL. Z10 <br /> CUSTOMER# -OW SP/RP NO. VOL <br /> MATERLAJ,DESCRIPTION: ASPHALT/CONCRETE <br /> PROFILE 4 408126-AP16:865-DIUI,R-P94 <br /> WASTE SOURCE (County/City location)-LIVERMORE <br /> 0 The Information listed above is necessary for acceptance of special waste at the <br /> Altamont Landfill. <br /> a A-copy of this form must be presented with each load to the Altamout scale house <br /> collector. <br /> 0 This form is for Altamont waste tracidn-use and is not intended to serve as a <br /> customer shipping document. <br /> a 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 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 ALTNT COLLECTOR USE ONLY: <br /> FILL IN TAGO ASSOCIATED WITH LOAD (USE OUTBOUND#FOR UNT.A.RED LOADS) <br /> SCALE HOUSE TAG <br /> DATE 42 5 -L <br /> TRUCK <br />