MSV TRUCKS 10.17 LOADSLoad Ticket
Ticket No. fo S V
Municipalipplicant) im Con rac r
8 44i C kb-
10 a �
CS-0 � � e
CS-0 r Sub- Contracto As
13g, AWNWME
d.�
Truck No Capacity
w4 OC71 '� e
Truck Driver (print legibly)
E-Man (,lam L U I s
Time
Loading
Location (Address or Cross Streets)
WE q -3r-d 5+
Debris Classification
Vegetation
❑ C &D
❑ White Goods
❑ HHW
❑ Other* See Below
ow
Unloading
---
Date Inspector /Monitor
5. TIC dil�
YAA
Estimated %, CYs, or Actual
Date l Ins
DMS Name and Location
V1 0 1 4N) 0 10 3 g"-4 .5i'r ➢�t,s� c � 4�' WjJ o, :3914-7
*Other Debris Explanation
Original: Applicant
Copy 1:
Copy 2:
Copy 3:
h
Load Ticket
Ticket Na.
Municipality (Applicant) P irn CO roc r
A _C Ila i
4 c ),6 Sub - Contractor
Mr4m" es r t
Truck No Capaciiy
s vi o
Truck Driver (print legibly)
f CO �1 r-
Time Date Inspector /Monitor
LC3c3di�1g .
i 0� �• Con Y�',1orr�
LocL-,,iq, ti Address or Cross St ets}
3rd S4 , Z, F6 a nth Avg
- - - 0, j '7
N I
Debris Classification
Estimated %, CYs, or Actual Weight
Vegetation
❑ C &D
❑ White Goods
❑ HHW
Other' See Below
Time
Unloading
Date Inspector /Monitor
l
DMS Name and Location
Il0 P tj 4�''s
*Other Debris Explanation
Original: Applicant
Copy 1:
Copy Z:
Copy 3:
Load Ticket Ticket No.
Municipa lity (Applicant) R im Con ra r
1 J.4 - 4 S
t r mss'. Sub- Contractor
Truck No
S 00
Truck Driver (print legibly)
Ely) nY1V-fI � Q i
Capacity
— 'a �
Time Date i Inspector /Monitor
Loading ,
Location (Address or
, Cross StresNEE;- g3' 5-C
M-[ e
W
Debris Classification
Vegetation
❑
C &D
El
White Goods
❑
HHW
❑
Other* See Below
VITA
Estimated %, CYs, or Actual
q5. 1
ht
Time Date Inspector /Monitor
Unloading , i d ,
DMS Name and Location DjaA--
C ?01 10 g 103 ""A— s° � Gr -{ . A lq7
r
`Other Debris Explanation
Originai: Applicant
Copy 1:
Copy Z:
Copy 3:
Load Ticket Ticket No.
Municipality (Applicant) p
p4 i AA41 C Jf� �s 61.4 4
106 SO V6 e0o"' A)f- Sub -C
alai &ass: S rtes, r tas va313ii` I
Truck No
31(o1
:k Driver (print
eW(/
Loading
- ocation (Address or Cross
(.t3 vE17�sl
N 2 I. %0;D
t3
1 1010
W- IKe ,107
�39 Vegetation
❑ C &D
❑
White HHW Goods f HHW❑ Other* See Below
Time Inspector /Monitor
Unloading )WI0 it. j /a_ n
*Other Debris Explanation
Original: Applicant
Copy 1:
Copy 2:
Copy 3:
h�li�I
Load Ticket S
Ticket No.
Municipality (Applicant) t! L" rac r
1OOSO ,.ag ra
® AJi awl
Mi4+vt: S u ®/dc5, aCa 83135
'ruck No CT 7 T •
y /� �%C (� Capacity
-47'i��y
uck Driver (print legibly)
0L( F2 A�cCJWM.Snf
L ading iris ecconMonitor
tion (Address or Cross Streets)
c =SST Pj
N s`. (6M 65s w �3D,
LP-ebrIsClassiflication Estimated %, CYs, or Actual Wei ht
Vegetation
❑ C&D
❑
White HHW Goods
❑ HHW a
❑ Other* See Below
Time Date Inspector/Monitor
Unloading
DMS Name and Location kqi�
t1o) 00 103 4- ST-I AAa9ll Firnd� $3/`(7
*Other Debris Explanation
Original: Applicant
Copy 1:
Copy 2:
Copy 3:
104Nw j J Soh A,i
Load Ticket
Ticket No.
4 i m o i iqa
V411
� ,
S
10OS0 Ne
fLJs
Sub -Contr cto
Truck No Capacity
ftoKk CO"
Time Date
Loading Inspector /Monitor
Iof('I S'-eah MOMS
Location (Address or Cross Streets)
VJ� I o3`d
V� E 514` FCC % 60J j g 16
N I
Vegetation
❑ C &D 7
❑ White Goods
❑ HHW
❑ Other* See Below
Unloading
DMS Name and Location '
i'701 f0w 103'e ST- 04iAm*41 *;7(stda a3r47
*Other Debris Exolanation
Original: Applicant
Copy 1:
Copy 2:
Copy 3:
P)Pj / SI
Load Tic et Ticket No, Y
Municipality (Applicant) R ' Con jraqjQr_
PliA4AI COr;eFL 1,4 - e- 0, 4M isms
10 06'0 P6 9 'a 4jj. Sub-Contra
m4m" e, oeac-Xlf 69 Im NO &"
mftrm,
Truck No oc-� Capacity
Truck Driver (print legibly)
/A/? L/ b('C
Loading Time f Date fnspector/Monitor
Location (Address or. Cross Streets) 2
Qebris C)
Classification Es
Vegetation
❑ C&D
0 White Goods
HHVV
❑ Other* See Below
Time Date 7-� �pector/�Momtor
Unloading 09
DMS Name and Location
10
7 *Other Debris Explanation
�'
Original- Applicant
Copy 1,
Copy 2:
Copy 3-
Load Ticket Ticket No,
Municipality (Applicant) P im CQ
a €� is,
a3 '�
.9r Sub - Contractor
Truck Nc Capacity
311 -3 j. '�-
Truck Driver (print legibly)
-F-4 I
Time Date inspector /Monitor
Loading
Location (Address or Cross Streets)
X7-1 IBC i�01�"�}
N 2y. k`lC- I
Debris Cfassficatforr Estimated %, CYs, r.F A_; Dual !:}lei i
Vegetation
❑ C &D
❑ White Goods
❑ HHW
❑ Other* See Befow
Time Date f nspector /Monitor
DMS Name and Location
"Other Debris Explanation
Originai: Applicant
Copy I:
Copy 2:
Copy 3:
Load Ticket Ticket No.
cket Ticket No*
Municipality (Applicant) P MIM Contrac r
V;
100670 Aj f-- Sub-Contractor
I ft
M
ruck F No
TL'rc"
u,00—
Frpuc;Driver (print le 1bly) j:!!73
� Q � �,e. \\,,
� Time Date
i —frspector/Monitor Loaciing * —r
L ocation
(Address or Cross Streets)
I
KI N. I
-7to Alt[
al S cias Ificatfon Estimated %, CYs, or Actual Weight
Vegetation
❑ C&D
❑ White Goods
❑ HHW
❑ Other* See Below q
Time Date Inspector /Monitor
Unloading
DIMS Name and Location
-0 � fQ 0 AAM,�P �StaJa. Sgjq7
*Other Debris Explanation
Original: Applicant
Copy 1,
Copy 2:
Copy I
Load Ticket Ticket No. -�J
Municipality (Applicant) P irm Confrac r
i4 40 fAM/ S,
a 019s o .06 ep F. Sub- Contractor S 11.3 6P
i 4L��4
Truck No
Capacity
Ms4 aq c i
Truck Driver (print legibly)
Time Date inspector /Monitar
Loading
Gy r'
Location (Address or Cross Streets)
�. C, q l
1w
Debris Classification Estimated %, CYs, or Actual W
Vegetation
❑ C &D
❑ White Goods
HHW
❑ Other* See Below
Time Date Inspector /Monit
[Unloading
DIMS Name and Location
1 a n s
7101 9J , ' �6 i'`Us'�'�fiA'4t f; {Csfajr, SS /Lf7
*Other Debris Explanation
Original: Applicant
Copy 1:
Copy 2:
Copy 3:
Load Ticket Ticket No.
Municipality (Applicant) FSub-(:,�-O�ritracta�r-
6S
trac r
s ';a V
100s o Joe
T.- -j C LO Capacity
3J 'S
Truck Driver (print legibly)
, Jc -/if
Time Date Inspector /Monitor
Loading : jt) .�
Location (Address or Cross Streets)
L�ti ,LC �7f� 5i
Debris Classiilcation Estimated %, Cys, c!-r:7772 `;'Iei
Vegetation
EJ Goads
L
See Below
Unloading Time
Date Ins ector /Monitor
l
DNfS Name and Location
11,01 5'c.°
"Cthe; Debris Explanation
Crig�nai: Applicart
Copy 1:
Copy 2.-
Copy 3:
Load Ticket Ticket No.
Municipality {Applicant} P Ccntrac r
Aq 4
A AA' 4 C- 00 ia V; S
_ t__
loarso �e- &9A Air-- Sub-Contractor
IM-1-6jili #a
ECM9=
32209AN91M
Rio Capacity
°I�- —N e 5
Truck Driver (print fogibly)
T Ljn, --e Date
Loading pe or
Location (Address or Cross Streets)
N ")-G, 46 � 15-� 1 VV —wo
Debris Classification Estimated "/,, CYs, or Actual Weight
Vegetation
❑ C&D
❑ White Goads
❑ HHW
❑ Other* See Below
Time Date Insp ctor/Moriftor
Unloading
DMS Name and Location
as ilf-7
' Cther- Debris Explanation
Crig�nai: Applicant
Copy 1:
Copy 2:
Copy 3:
Load Ticket Ticket No.
Municipality (Applicant) P im Cants r
r-A av ,
10 o i-1: "'s I ��� Su b -Cc; Tractor
WOA
Truck No Capacity
3-1(11 3 I
Truck Driver (print legibly)
I
Time Date Inspector /Monitor
Loading
Location (Address or Cross Streets)
N - SC— CS`j , "
• I i I
Debris Classification I Estimated °1/o, CYs, or Actual Wei
Vegetati o n
[j C &D
White Goods
HHW .
❑
Other* See Below
Time Date inspector /Monitor
Unloading
b� l
DMS Name and Location
-Other Debris Explanation
Original: Applicant
Copy 1:
Copy 2.-
Copy 3: