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FORWARDr SITE TICKET _ GRID <br /> INC0R ? ORATED - <br /> 199 South Ausfln Road/WEIGHING LOCATION PO Box 6336 WEIGHMASTER <br /> nt ca, CA 95336 Stockton, CA 95206 <br /> a (209) 982 4298/WEIGHING LOCATION Main Office (209) 466 4482 DATE IN TIME IN <br /> tes Recovery (209) 982-4936 Fax (209) 465-0631 _ <br /> I _ , <br /> DATE OUT TIME OUT <br /> - <br /> _ <br /> - VEHICLE ROLL OFF <br /> " REFERENCE ORIGIN <br /> �Z <br /> QTY UNIT 7DESCRIION RATE, . 3EXTENSION- TAX TOTAL <br /> 4 <br /> I <br />'EIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following desenbed commodity was weEghed measured or counted by a weighmaster whose signature is <br /> his certificate who is a recognized authority of accuracy as prescribed by Chapter 7 (commencing with Section }2700)of Division 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 /> TENDERED <br /> Ir CHANGE <br /> CHECK NO <br /> k, <br /> DRIVER'S SIGNATURE <br /> I �rc <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 (TO BE COMPLETED BY LANDFILL) <br /> I is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS o SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> I SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> {� ©WOOD <br /> r r <br /> f Q ASH <br /> C1 SPECIAL OTHER <br /> SCHI_DULING MUST BE MADE PRIOR TO 3 W P M THE DAY PRI ORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> I TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> SALES COPY MANIFEST# <br />