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■ (tTORWARD �.ISW�141 '01%'- 1GK�T ` 4i H GRID INCORPpRATED 1E340 <br /> 9 South Austin Road/WEIGHING LOCATION P O Box 6336 +- ` WI;IGHMA EF 4" <br /> InWCecovery <br /> A 95336 Stockton, CA 95206 VICTORIA <br /> an 209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 '� ;N�*s �. ATE IN_ . r > K TIME IN <br /> (209) 982-4936 Fax (209)465-0631 4 June 12003 2:03 pm <br /> 00 3365 ;`-z'^TIME OUT <br /> ADVANCED GEO ENVIRONMEN-rAL 4 lune 2003 2:(`,3 pm <br /> PAUL DOTSON k VEHICLEu i +1; 7 1 7r, Rou.oFr- <br /> 927 SHAW ROAD IJ INN W56 t <br /> STOCl:TI N e CA 95215 F1EFERE� -sf- r j;, � oR1GIN Contract.- 3365tk TRACY <br />' 00 Gross Weight 777,7A(f .0() L9 Inbound _ SCALE TICI,ET <br /> Stored Tare Weight 2S%460.00 LD <br /> Net Weight 49,300.0(.7 LB 24.e35 TN <br /> $ ClY- t1Nit-'- DESCAIF'TION' " <br /> F6 1 1 RA's - + 1 EXTENSION ' TAX TOTAL <br /> 24. 63 TN 16 STCI.CI ILE <br />' t <br /> C� <br /> GHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a weighmaster whose signature is <br /> his c=e 'Cite who is a recognized authority of accuracy as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the Calrfomta Business <br /> Professions Code administered by the Div#sion of Measurement Standards of the California Department of Food and Agriculture <br /> N AMOUNT <br /> 1`)[;,141 F ES T 4220""Se TENDERED <br /> CHANCE <br /> CHECK NO <br /> DRIVER'S SIGNATURE --- <br /> CUBIC YARDS <br /> II 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 /> REMARKS U SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTWRIZEDAGEN DATE <br /> Q OOD <br /> U ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 3 OO P M THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> ITO REFUSAL UPON AR� IVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> tt Y�� <br /> SALES COPY MANIFEST#2207500 <br /> 2207500 <br />