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SITE TICKET GRIP <br /> INC 0R PO RA TED <br /> 199 South Austrn Roa WEIGHING LOCATION P O Box 6336 WEIGHMASTER <br /> %&a, CA 95336 Stockton, CA 95206 <br /> a (209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE:IN TIME IN <br /> elm Recovery (209) 982-4936 Fax (209) 465-0631 ' <br /> _ - DATE OUT TIME OUT <br /> FNM J f JS - 1 <br /> VEHICLE ROLL OFF <br /> r '3 REFERENCE ,ORIGIN <br /> OTY UNIT DESCRIPTION RATEEXTENSION 5 TAX* L TOTAL <br /> t <br /> IV <br /> I <br /> EIGHMASTER CERTIFICATt THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a weighmaster whose signature is <br /> 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 /> III Professions Code admsnistered by the Division of Measurement Standards of the California Department of Food and Agriculture <br /> NET AMOUNT <br /> TENDERED <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 /> IDISPOSE OTHER <br /> ❑SOIL <br /> IREMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> I SIGNATURE OFAUTHOf914ED AGENT DATE ASBESTOS <br /> O WOOD <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY POIORTO 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� y <br />