Laserfiche WebLink
02/24/2ee4 E)8:49 20SS252,-153 0-ITY �l89 '°N`�Nd90�Z tiIOZ Zl '�nyPawil paniaaa� : <br /> CITY OF M�1NTE�WOCP <br /> VYA9TE HAULER'S SoURCiLCERTIFICAT qN <br /> Rev. 3100 <br /> 1. PRODUCER OF L.IlQU10 WASTE <br /> NAME S�•S P SC �P , Pt�ON <br /> PICK-UP ADDRESS ��D�D S �� LZIX Lc ii/t c'O C <br /> Number Street City state Zip <br /> WASTE SOURCE: DOMEST C STEWATER ONLY from (aircie one); SmpUc Tank portable Tollet <br /> I WR <br /> DUANTITY �L gals <br /> PICK-UP DAT ,TIM <br /> 1 certify that this waste was delivered to the hauler named below for legal disposal at the site indicated. <br /> 1-9- "� aj <br /> Printed Name of Owner,Occupant or Agent signatura of aw &UP r A <br /> 2. HAILER 1 <br /> NAME�U <br /> BUSINESS ADDRESS 72r�2 —&jvl <br /> Number Street City State Zip <br /> I certify that the described waste was hauled by me tv the disposal faclety named below. <br /> Receiving Station Permit No.,,^/171-- ' / Vehicle License No.,�-- � <br /> G� <br /> etas �e <br /> Printwd Name of Hauler Signature of Hauler, <br /> 3. RECEIVING§ATION <br /> NAME AND ADDRESS: City of Manteca WQCF 2450 West Yosemfte Ave. Manteca, 95337 <br /> I c®rntu rn2t ino hsular sWive dellvwrod the dwscab'e l NOI +w'%tr 1,11 :11k 111MIniNn1 fn%dfily, Aod lhal it wa3 <br /> accepted/rejected(circle one) material under the terms of the Raceiving SWUM Pertt'tit, <br /> ignaturc of Waste ity Operator <br /> DATE �M L_TIME IN12- ,OTIME oU`f 12.2 6 M NET QUANTITY 3I d-1 gals. <br /> 90/VO 39Vd �0100�i 0101 K6559b60z 89:8T bTOZ/ZT/80 <br />