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FORWARD SITE TICKET GRID <br /> INCORPORATED <br /> pt <br /> South Austin Road/WEIGHING LOCATION P O Box 6336 WEIGHMASTER <br /> eca, CA 95336 Stockton, CA 95206 <br /> a (209) 982-4298/WEIGHING LOCATION Main Office (204) 466-4482 DATE IN- TIME IN <br /> oes Recovery (209) 982-8936 Fax (209) 465-0631 - <br /> DATE OUT TIME OUT <br /> VEHICLE ROLL OFF <br /> ""' REFERENCE a ORIGEN <br /> I r 5 <br /> QTY r UNIT I L DESC ON RATE `EXTENSION } TAX, TOTAL <br /> EIGHMASTER CERTIFICA7E THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a weighmaster whose signature is <br /> h1s 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 /> Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture <br /> NET AMOUNT <br /> _ TENDEREf] <br /> CHANGE <br />' CHECK NO <br /> DRIVER'S SIGNATURE <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 /> Is true and accurate <br />' DISPOSE OTHER <br /> b SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER } } DEBRIS <br /> r r ❑ NON-FRIABLE <br /> SIGNATURE OFAUTHORIZED AGENT DATE 1 j, <br /> ASBESTOS <br /> 4 �1 0 WOOD <br /> CJ ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 Oa PM 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# , <br /> w� t r Q <br />