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LOADCHECK FORM <br /> Date: Page No. <br /> Time: <br /> Hauling Firm or Vehicle Identification: <br /> Type of Business: <br /> Hauling Firm Telephone No.: <br /> Driver's Name: <br /> Vehicle License Plate No.: <br /> Truck No.: <br /> Type of Waste: <br /> Was Prohibited Waste Found? Yes No <br /> If Yes, Type of Prohibited Waste: <br /> Source of Waste: <br /> Brief Summary of Incident: <br /> Observation Notes: <br /> Resolution: <br /> Notification to Agencies Required: Yes ) No <br /> Loadchecker Name (print): <br /> Loadchecker Signature: <br /> Driver Name (print): <br /> Driver Signature: <br /> ZAProjects\A11ied Waste\Forward\Five Year Permit Rvw 2013\Jtd-5 Yr Pr 2013\Appendices\App S 2006 Load Check <br /> Program\Form-Lc.Doc:51312013 <br />