HomeMy WebLinkAboutSeptage Hauler Manifest Template
TRUCK CAPACITY TRUCK LICENSE # SOURCE SERVICE DATE FACILITY TYPE WASTE DESCRIPTION NAME FOOD SERVICE PORT TOILET ADDRESS GREASE TRAP PHONE GALLONS -EST. SEPTIC TANK OTHER OTHER SOURCE
SERVICE DATE FACILITY TYPE WASTE DESCRIPTION NAME FOOD SERVICE PORT TOILET ADDRESS GREASE TRAP PHONE GALLONS -EST. SEPTIC TANK OTHER OTHER SOURCE SERVICE DATE FACILITY TYPE WASTE DESCRIPTION
NAME FOOD SERVICE PORT TOILET ADDRESS GREASE TRAP PHONE GALLONS -EST. SEPTIC TANK OTHER OTHER SOURCE SERVICE DATE FACILITY TYPE WASTE DESCRIPTION NAME FOOD SERVICE PORT TOILET ADDRESS
GREASE TRAP PHONE GALLONS -EST. SEPTIC TANK OTHER OTHER SOURCE SERVICE DATE FACILITY TYPE WASTE DESCRIPTION NAME FOOD SERVICE PORT TOILET ADDRESS GREASE TRAP PHONE GALLONS -EST. SEPTIC
TANK OTHER OTHER DRIVER'S NAME (PRINT) DRIVER'S SIGNATURE DATE NOTES RESIDENTIAL RESIDENTIAL NOTES RESIDENTIAL RESIDENTIAL COMPANY NAME RESIDENTIAL CITY SEPTAGE DISPOSAL PERMIT # NOTES
NOTES CERTIFICATION: I certify that the information listed on this Hauler Manifest/Tracking Form is true, accurate and complete to the best of my knowledge. I am aware of the conditions
and requirements of my septage disposal permit and understand that failure to comply with those conditions and requirements can result in the immediate suspension or revocation of my
permit and its disposal privileges with the City of Bakersfield as well as the enforcement of possible penalties as may be allowed by law. (661) 326-3249 NOTES BY PERMISSION ONLY BY
PERMISSION ONLY BY PERMISSION ONLY BY PERMISSION ONLY BY PERMISSION ONLY CITY OF BAKERSFIELD HAULING MANIFEST /TRACKING FORM BAKERSFIELD, CA 93313 6901 McCUTCHEN RD WASTEWATER DIVISION
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