| Company Name: |
____________________________________________ |
| Contact Person for
Truck Info: |
____________________________________________ |
| Contact Person for
Billing: |
____________________________________________ |
| Mailing Address: |
____________________________________________ |
| City: |
________________________ |
State: |
____________ |
Zip: |
______________ |
| Actual (Physical) Address: |
____________________________________________ |
| City: |
________________________ |
State: |
____________ |
Zip: |
______________ |
| Telephone Number (Include
Area Code): |
(_____)
___________________________ |
| Additional Telephone
Number: |
(_____)
___________________________ |
| Type of Waste to be
Disposed of: |
_________________________________________
|
|
(To see waste table,
click here.) |
| Is this Waste from Mercer County, NJ? |
_______ Yes _______
No |
NOTE:
IF NO, YOU CANNOT DUMP IN MERCER COUNTY!!
|
|
Type of Account: |
__________ One
Load (For
info on excess deposit refunds, click here.) |
| __________ Continuing
Activity |
Truck Information:
| |
DEP
Number
(5 Numbers) |
Decal
Number |
Vehicle
Plate Number |
Capacity
(Tons / Cu Yds) |
Type of
Truck |
| 1 |
|
|
|
|
|
| 2 |
|
|
|
|
|
| 3 |
|
|
|
|
|
| 4 |
|
|
|
|
|
|
FOR AUTHORITY USE ONLY |
| Account Number:
_________________ |
Deposit:
$______________________ |
| |
(Minimum $250.00) |
|