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r I! <br /> ALTAMONT LANDFILL <br /> WASTE ACCEPTANCE FORM <br /> CUSTOMER NAME: JAMES L. HOBLITZELL <br /> 1� <br /> CUSTOMER: 41175 <br /> PROFILE: 451995000 <br /> GENERATOR NAME: LIT"I'Lfi BIGHORN TRUST <br /> E MATERIAI. DESCRIPTION: CLASS 11 COVER S0112� I. <br /> WASTE SOURCE (County /City location) - STOCKTON i t <br /> Y <br /> FLAG COLOR: YELLOW <br /> I� <br /> 4I <br /> The Information listed above is necessaryfor acceptance of special waste at the Altamont <br /> p. P <br /> Landfill. 'I <br /> j t <br /> • A'copy of this form must be presented with each load-to the;Altamont Landfill scale <br /> house collector. R <br /> • This form is for Altamont Landfill waste tracking use,and is not intended to serve as <br /> a customer shipping document. <br /> • Drivers will receive a weight ticket for confirmation of disposal. <br /> • An alternative shipping record may be used in lieu of this form if it includes the <br /> above information. <br /> • If shipping form is a multiple part form, please notify 4andfill of which copies to <br /> return with the driver, if not othenvise noted on theform. <br /> ;f <br /> ----------------------------------------------------------------------------- ------ , -------------------- <br /> FOR ALTAMONT LANDFILL COLLECTOR USE ONLY: .>. <br /> 4 <br /> FILL IN TAG# ASSOCIA'T'ED WITH LOAD (USE OUTBOUND# FOR UNTARED LOADS) <br /> SCALE HOUSE TAG # - <br /> ,DATE <br /> it <br /> TRUCK # Ii <br /> ` f� <br /> I� t <br /> I <br />