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STOCKTON REGIONAL • i • FACILITY <br /> WASTE HAULER MANIFEST FORM <br /> TO BE COMPLETEDBY WASTEBEFORE <br /> PLEASE PRINT AND PRESS HARD. INCOMPLETE OR ILLEGIBLE FORMS WILL NOT BE ACCEPTED. <br /> Waste Hauler • •.Vehicle License ` <br /> • <br /> • D. •. <br /> Complete name, address, type, and quantity of waste source(s) below. A signature shall be obtained from a (7" <br /> representative from each source, verifying the type and quantity stated. If more than four sources in the waste <br /> load, attach additional forms. Random verification will be made by SRWCF. _73 <br /> Zip • . •ti �►=:ref J.�.a7�C��i��]�G7 G•',.4;•1�.<••!": o�i�"_�`• � <br /> Phone No.j <br /> Waste Type: Quantity.-_gal. <br /> Generator Signature., R <br /> Y'l i C• +fir !! D rr !1 l fC. •.�_' �71p' j �7r' �1 1,� ti' <br /> Within Stockton city limits? Yes No <br /> � ,�1 i �f :t +J�-` L :4 -� •� + .} � f ��_',,v• �.il'_^I.a�+ iS."1.^a_•;) �1���<.]. r�, ��� . 1 <br /> �`"J4 '' y�}\+.` �Z),a� r7{'f'1.�' t-,'4'�`•f��}+.�.i`��. c�,.a.�>t:.'��{f.,f�' C�*.+ <br /> .,:�}• ��,-� -�.:;p�7�.f=2r0�1 z2'0�2 0 13 16 <br />