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FORWARD SITE TICKET GRID <br /> Vi►� - INCORPORATED 1 <br /> 9 South Austin Road/WEIGHING LOCATION P.O. Box 6336 UWLLL WEIGHMASTER <br /> -it,�-a,CA 95336 Stockton,CA 95206 <br /> 3I (209)982-4298/WEIGHING LOCATION Main Office:(209)466-4482 DATE IN TIME IN <br /> oLme Recovery:(209)982-4936 Fax: (209) 465.0631 0B7207198 vtj U6 <br /> 736721 DATE OUT TIME OUT <br /> 'HORIZON ENVIRONMENTAL 087207178 CIS:23 <br /> <EN MATE I K VEHICLE ROLL OFF <br /> 011 GOLDEN FOOTHILL PKWY - #7 <br /> EL DORADO HILLS CA 95762 REFERENCE ORIGIN <br /> 736721 F q <br /> RMER DISCOVERY CHEV <br /> Scale 1 Gross Weight 75400 LB Inbound - Charge ticket <br /> Scale 1 Tare Weight 31700 LB <br /> Net Weight 43700 LB <br /> QTY. UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> X1 .85 T INS Class Il Soily Ton <br /> k <br /> �PfRM4TE #HIS LZZO lSfjThat the following described Commodity was weighed.measured,or counted by a weighmoster,whose signature is NET AMOUNT <br /> Lri ,wl is a recog �f accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business <br /> Pr e,administere ivision of Measurement Standards of the California Department of Food and Agriculture. <br /> ` TENDERED <br /> [TRAILER# 1VX4871 <br /> Schedule 24 hours in advance directly with the landfill . CHANGE <br /> Call (209)982-4298 to schedule. <br /> Drive Safe 1 y ! ! CHECK NO. <br /> C t <br /> cycled p= <br /> DRIVER'S SIGNATURE r � ij recreel == <br />