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' FORWARD SITE TICKET GRID <br /> INCORPORATED <br /> 9?2 South Austin Road/WEIGHING LOCATION P.O. Box 6336 WEIGHMASTER <br /> ca,CA 95336 Stockton,CA 95206 1 C`'r <br /> F II:(209)982-4298/WEIGHING LOCATION Main Office: (209)466-4482 DATE IN TIME IN _ <br /> Resource Recovery:(209) 982-4936 Fax:(209) 465-0631 2B Jul;;-, _062 r);:a F-ai <br /> Z?. DATE OUT. TIME OUT <br /> }�F';.1fJl�D ZE(-C(.,1 ANAL_'r .,11S �: ._FuniR 2I..�C.)2 i f cf <br /> ...E Nl•:r: C�riR.YE_'Y VEHICLE t <br /> ROLL OFF <br /> J r J.4 MAIN <br /> ES/CAt_01q s C',A yc-_`,, REFERENCE ORIGIN <br /> ;aTOCfi..TON <br /> lf_.' Li'l Com- Ws'u �:(✓ hclr,:_ pis;? ` i Cil1•ilsllii SCALE i ""T <br /> Net Weiq,�-iL a.44(, R 1 .EE' Tt4 <br /> CITY. UNIT DESCRIPTION RATE. EXTENSION TAX TOTAL <br /> WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed,measured,or counted by a weighmaster,whose signature is <br /> on this certificate,who is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business <br /> and Professions Code,administered by the Division of Measurement Standards of the Ca#ifomla Department of Food and Agriculture. <br /> NET AMOUNT <br /> TENDERED <br /> CHANGE <br /> CHECK NO. <br /> 1; <br /> DRIVER'S SIGNATURE r f <br /> r� <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: t (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> ❑SOIL <br /> REMARKS J CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ;r, J NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED•AGENT/ .DATE <br /> :.I WOOD <br /> DASH <br /> SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL,.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR CaP`,' <br /> MANIFEST#15 Q .Q.+4 <br />