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CI TY OF L)TOCKTON <br />PERIODIC LOAD- CHECKING FROG.*F.AIM <br />(Name & Title) <br />r e p r e s e n t a t i n g <br />(Name of Company) <br />(Address) <br />(City, State, Zip) <br />collected the toxic materials found by the City of Stockton during its <br />load --checking program at the Austin Road Landfill and agree to dispose <br />of it properly. <br />Within seven (7) calendar days, I agree to deliver to the City of <br />Stockton proof (proper documents and/or manifests) that the subject <br />toxic materials were disposed of properly. <br />Signed: <br />Date: <br />