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MANUAL TICKET <br />7484 <br />FRONT RANGE LANDFILLS INC. <br />1830 WCR FIVE <br />P.O. Box 320 <br />ERIE, COLORADO 80516 <br />Phone: (303) 673 -9431 <br />Fax: (303) 673 -9432 <br />Name:..(- <br />r, a <br />1 ' <br />Acct. # <br />Date: i <br />Time, ; am pm <br />Covered O Uncovered Q <br />Cash 0 . Charge -.p <br />Computer Replacement <br />Date <br />Ticket # <br />Vehicle Type <br />Waste <br />code <br />Approved Code <br />or other Info <br />Quantity <br />Base <br />Colo US <br />Weld US <br />Total Amount <br />Front Loader <br />Rear Loader <br />Roll Off <br />Side Loader <br />Transfer <br />I certify that this waste contains no hazardous matynal as defined by the Resource <br />Conservation and Recti_ v Act. <br />Truck # ,r <br />Container # <br />Driver Signature <br />Gross � � ry <br />4 <br />Tare i j Authorized by <br />Net 1. Payment due 10 days from imroice date. <br />2. All uncovered loads wilfbe charged double the normal rate. <br />Net Tons 3. No liquids, sludges, or hazardous materials will be accepted. <br />