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10 cubic yard bins maximum 5 TONS: Dirt, Concrete, Gravel and Asphalt are accepted <br />20 cubic yard bins maximum 3 TONS: Trash and All types of roofing - No Dirt/Concrete <br />40 cubic yard bins maximum 4 TONS: Trash and Woodshake roofing only • No Dirt/ Concrete <br />Additional charges may apply if bins exceed the maximum weight limit. All bins with waste above the rim <br />will be charged additional daily charges until bin is leveled and removed. <br />UPON CUSTOMER REQUEST FOR BIN PLACEMENT, REPUBLIC SERVICES IS NOT RESPONSIBLE <br />FOR ANY DAMAGE TO DRIVEWAY AND/OR PROPERTY. <br />Republic Services DOES NOT accept the following waste types: <br />LIQUID - PAINTS - OIL - TIRES - GREASE - PESTICIDES - SOLVENTS - CHEMICALS- FREEZERS <br />ICE MAKERS • REFRIGERATORS- AIR CONDITIONERS - TOXIC, RADIOACTIVE, EXPLOSIVE, HIGHLY <br />VOLATILE, FLAMMABLE, or HAZARDOUS MATERIALS. <br />DRIVER k k k ' ." REPUBLIC 1-- '1 7 2( <br />SERVICES DATE <br />TRUCK NO. L.' -k- --- TIME —7 .C- , AM/PM <br />1 1 —Z. k, ( k ,, <br />CUSTOMER <br />ADDRESS <br />Acct, No. Total Tons: <br />QUANTITY ,----DESCRIPTION ss) <br />' -• <br /> BIN PICKED UP <br />° <br />Li GOOD 1_1 FAIR <br />0 POOR <br />BIN DELIVERED <br />0 GOOD I.) FAIR <br />0 POOR <br />DELIVERED TO: 0 ESTS VForward 0 R&R 0 SR 0 Lovelace 0 Harney Lane El Yard 0 Other: <br />I CERTIFY THAT NONE OF THE ABOVE WASTE TYPES ARE CONTAINED IN THIS LOAD. <br />I have read and understand Republic Services Policy: Signed <br /> <br />NS-019 (17/14) <br />d Generators Name and Locatio <br />f Phone <br />It owner of the generating facility <br />h Owner's Name <br />j Waste Profile # <br />GENERATOR'S CERTIFICATIC <br />state law, has been properly der <br />waste is a treatment residue of <br />been treated in accordance with <br />p Generator Authonzed Agent I <br />TRANSPORTER <br />iii. <br />a. Disposal Facility and Site Address <br />b <br />c US EPA Number <br />_. <br />d Discrepancy Indication Space: <br />— <br />I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing Is true and accurate. <br />— e. Name of Authorized Agent (Pnrit). <br />f. Signature <br />... . <br />A. Date <br />IV. • <br />a Operator's Name and Address c Responsible Agency Name and Address: <br />d. Phone <br />b Phone <br />e Special Handling Instructions and Additional Information <br />El Non-Fnable 0 Both % Fnable % Non-Fnable <br />f 1:l Friable OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descnbed ats.yes by the pimner stiexeng reams <br />and are classified packaged, marked and labeled/Placarded, and are in all respects in proper condition for transport according to appecaido international and <br />regulations national govemmental <br />Operator's Name and Title (Print) g. It Signature I Date .. . <br />'Operator refers to the company which owns, leases, operates, controls, or upervises the facility being demolished or renovated, or the demoShion or <br />renovation operation or both <br />aft.p, <br />REPUBL <br />6 06 SERVICES • <br />-50 <br />I. GENERATOR (Gt <br />a Generator's OS EPA ID Numbt <br />• <br />a Transporters Name and Address <br />b Phone <br />c Driver Name (Pnnt) d. Signature e. Dale <br />Destination Site completes Illa- <br />REV 04/19 GENERATOR RETAIN R5 15A