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FORWARD srTE, TICKET� GRI° <br /> + K <br /> 9 South Austin Road/WELG}IING LOCATION P 0 Box 6336 WEIGHMASTER <br /> nteca, CA 95336 ` ^S` <br /> 5tocktan, CA 95206 <br /> an 209) 982 4298/WEIGHING LOCATION Main Office (209) 466-4482 " DATE IN TIME IN <br /> les Recovery (209) 902 4936 Fax (209) 465-0637 k (^ Lc a <br /> DATE OUT TIME OUT <br /> _r r ,S <br /> VEHICLE ROLL OFF <br /> REFERENCE ORIGIN <br /> Qom' UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> I y <br /> EIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodrfy was weighed measured or counted by a weighmaster whose signature is <br /> is certificate who is a reccgnrzed authority of accuracy as prescribed by Chapter 7(commencing with Section 12700)of DIvislon 5 of the California Business <br /> Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture <br /> NET AMOUNT <br /> 104w1 TENDERED <br /> . 1 , <br /> I <br /> CHANGE <br /> CHECK NO <br /> ©RIVER'S SIGNATURE <br /> P � <br /> CUBIC YARDS <br />' 1 hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br />' <br /> is true and accurate <br /> DISPOSE OTHER <br /> FIEMARKS a SOIL <br />' ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> r ❑WOOD <br /> i / V <br /> ❑ASH <br /> ! ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO 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 /> SALES COPY MANIFEST# +) s w n ,' " <br /> R L) $ { • - <br />