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COMMERCIAL • INDUSTRIAL • RESIDENTIAL
1547 W. Grand Ave., Pomona, CA 91766
TEL: .(626) 272 72-44, (626) 617-5254
Dto ., i 20 ` • P.O.
Custo7ner
Delivery Address
Phone #
T.G. Amount Due $ _,
PAY: ❑CREDIT CARD❑ CASH D CHECKO BILL Driver
40 CU. YD. ROLL -OFF CONTAINER
No Concrete, Dirt, Sand, Asphalt, Brick, etc. DELIVER ❑
No Hazardous Materials, Tires, Paint, Household Appliance, Batteries and
Computer, etc. as directed by State/Federal: Regulations are accepted in loads REMOVE ❑
Signature X EXCHANGE '❑
❑ LOW BOY ROLL -OFF CONTAINER
❑ Clean Concrete ❑ Clean Dirt ❑ Bricks/ Rock ❑ Asphalt ❑ Sand
Low Boys are designed for the inert materials only: Rock, Concrete, Bricks, Asphalt and clean Dirt
free of Grass and Roots. If Low Boy is contaminated with other material including Trash, Wood
Glass and Metal, etc. contamination charge will be assessed based upon severity of contamination.
Signature X
d SERVICE CHARGE
❑.STON LIMIT • „ o
* MUST CALL FOR PICK UP *You Got Overweight
(Allow 48 hours after box is loaded for removal, unless otherwise agreed on.)
*We reserve the right to refuse to haul any.excessively or incorrect loaded containers.
*All material must be loaded within the container and shall not exceed the top level of the container.
*Customer agrees to provide clear access to the container for loading and unloading. If a driver
is required to wait over 15 minutes, and idle charge of $100 will result.
*An extra charge of $150 will be made for any unnecessary trips due to excessive or incorrect loading.
*We are released of liability for all damages caused by container and/or truck when providing
service as directed by a customer or their agents.
*Customer agrees to pay for any damage to container while in his/her custody and care.
*Customer is fully liable for lost or stolen container.
*Cancellation must be made at least 24 hours prior to scheduled delivery date, otherwise
cancellation fee of $150 will result.
*If collection action is required, customer agrees to pay all collection costs including attorney's fees.
*If you don't pay for the dump, we will dump it -back.
Signature X
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R.Serna Roll Off Service
fja
COMMERCIAL INDUSTRIAL • RESIDENTIAL-'
s
1547 W. Gr ve.; mona, CA 917.66
TEL: 6) 2.74-7244 (626) 617-5254
D to '� `'`? P.O.
20F F
Cu omer°`°
Delivery Address
Phone #
T.G. Amount Due $
PAY: ❑CREDIT CARD❑ CASH D CHECKell B ' ,,Driver
0 40 CU. YD. ROLL -OFF CONTAINER
yvU/
,��
No Concrete, Dirt, Sand, Asphalt, Brick, etc.
DELIVER 0
No Hazardous Materials, Tires, Paint, Household A pliance, Batteries and
Computer, etc. as directed by State/Federal Regulations are accepted in loads'` REMOVE ❑
Signature X \\ ~'` — — '
EXCHANGE.❑`lY
❑ LOW BOY ROLL -OFF CONTAINER
❑ Clean Concrete ❑ Clean Dirt ❑ Bricks/ Rock ❑ Asphalt ❑ Sand
Low Boys are designed forthe inert materials only: Rock, Concrete, Bricks, Asphalt and clean Dirt
free of Grass and Roots. If Low Boy is contaminated with other material including Trash, Wood
Glass and Metal, etc. contamination charge will be assessed based upon severity of contamination.
Signature X
❑ SERVICE CHARGE
❑ STON LIMIT N . ° 1 „ •
* MEMO
* MUSTCALL FOR PICKUP *You Got overweight
- lA lln,n,A4i.r,,.�-•F`... L..... :�I..-J-J L_.. _____.-_1 --.-,- .
„v. -- Ip CU UI 1.)
*We reserve the right to refuse to haul any excessively or incorrect loaded containers.
*All material must be loaded within the container and shall not exceed the top level of the container.
*Customer agrees to provide clear access to the container for loading and unloading. If a driver
is required to wait over 15 minutes, and idle charge of $100 will result.
*An extra charge of $150 will be made for any unnecessary trips due to excessive or incorrect loading.
*We are released of liability for all damages caused by container and/or truck when providing
service as directed by a customer or their agents.
*Customer agrees to pay for any damage to container while in his/her custody and care.
*Customer is fully liable for lost or stolen container.
*Cancellation must be made at least 24 hours prior to scheduled delivery date, otherwise
cancellation fee of $150 will result. _--~ "
*If collection action is required; customer agreestopay-all collection costs including attorneys fees.
_.
*If you don't pay for -the dump, we will dump it"back:. -
Signature")( .
R.Serna Roll Off
Service
COMMERCIAL • INDUSTRIAL • RESIDENTIAL
1547 W. Grand Ave., Pomona, CA 91766
TEL: (626) 274-7244, (626) 617-5254
3 Date C� `?20 *:
P.O.
Customer M
Delivery Addr ss -,7 K ;.-
4, .f Phone #
T.G. Amount Due $_ '
PAY: L CREDIT CARDO CASH D CHECKO BILL Driver
, 40 CU. YD. ROLL -OFF CONTAINER
No Concrete, Dirt, sand, Asphalt, Brick, etc. I
No Hazardous Materials, Tires Paint; Hbusehold`Ap limce, Batteries,and DELIVER
Computer, etc. as directed by Statee/Fed,F Regulations are'accepted in loads
REMOVE
Signature
EXCHANGE 0
❑ LOW BOY ROLL -OFF -CONTAINER
❑Clean Concrete leanDirt ❑Bricks/Rock
❑ Asphalt ❑ Sand
Low Boys are designed for the inert materials only: Rock, Concrete, Bricks, Asphalt and clean Dirt
free of Grass and Roots. If Low Boy is contaminated with other material including Trash, Wood
Glass and Metal, etc. contamination charge will be assessed based upon severity of contamination.
Signature
❑ SERVICE CHARGE
Z5TON LIMITLESEMEECT67M.
*IN
®�
e� •
* MUST CALL FOR PICK UP '
ght
(Allow 48 hours after box is loaded for removal, unless othherGot wisei agreed on.) .
*We reserve the right to refuse to haul any excessively or incorrect loaded containers.
*All material must be loaded within the container and shall not exceed the top level of the container.
*Customer agrees to provide clear access to the container for loading and unloading. If a driver
is required to wait over 15 minutes, and idle charge of $100 will result.
*An extra charge of $150 will be made for any unnecessary trips due to excessive or incorrect loading.
*We are released of liability for all damages caused by container and/or truck when providing
service as directed by a customer or their agents.
*Customer agrees to pay for any damage to container while in his/her custody and care.
*Customer is fully liable for lost or stolen container.
*Cancellation must be made at least 24 hours prior to scheduled delivery date, otherwise
cancellation fee of $150 will result.
*If collection action is required, customer agrees to pay all collection costs including attorneys fees.
*If you don't pay for the dump, we will dump it back.
Signature X
R.Serna Flail Off Serviceax
COMMERCIAL e INDUSTRIAL e RESIDENTIAL j
1547 W. Grand Ave., Pomona, CA 91766
TEL: (626) 274-7244, (626) 617-5254
Date ;
.� =��f � 20 ' �` '� P.O. 7
Customer
i
Delivery Address;a
' F �.V,/" I,` F Phone#
T.G.
Amount Due $
PAY: ❑CREDIT CARD❑ CASH D CHECK❑ BILL Driver
140 CU. YD. ROLL -OFF CONTAINER
No Concrete, Dirt, Sand, Asphalt, Brick, etc. DELIVER ❑
No Hazardous Materials, Tires, Paint, Household Appliance, Batteries and
Computer, etc. as directed by State/Federal Regulations are accepted in loads REMOVE ❑
SignatureX-. "� `' EXCHANGE
LOW BOY ROLL -OFF CONTAINER
[]Clean Concrete ❑Clean Dirt ❑Bricks/ R k ❑ A
oc sphalt ❑ Sand
Low Boys are designed for the inert materials only: Rock, Concrete, Bricks, Asphalt and clean Dirt
free of Grass and Roots. If Low Boy is contaminated with other material including Trash, Wood
Glass and Metal, etc. contamination charge will be assessed based upon severity of contamination.
rF
Signature X r ,n-�,� -
SERVICE CHARGE'
'[15TON LIMIT
* MUST CALL FOR PICK UP *You Got overweight
(Allow 48 hours after box is loaded for removal, unless otherwisP anreed on)
*We reserve the right to refuse to haul any excessively or incorrect loaded containers.
*All material must be loaded within the container and shall not exceed the top level of the container.
*Customer agrees to provide clear access to the container for loading and unloading. if a driver
is required to wait over 15 minutes, and idle charge of $100 will result
*An extra charge of $150 will be made for any unnecessary trips due to excessive or incorrect loading.
*We are released of liability for all damages caused by container and/or truck when providing
service as directed by a customer or their agents.
*Customer agrees to pay for any damage to container while in his/her custody and care.
*Customer is fully liable for lost or stolen container.
*Cancellation must be made at least 24 hours prior to scheduled delivery date, otherwise
cancellation fee of $150 will result.
*If collection action is required, customer agrees to pay all collection costs including attorney's fees.
*If you don't pay for the dump, we will dump it back.
6e
Signature
IA,Serna Rail off serv-ce'
COMMERCIAL ® INDUSTRIAL ® RESIDENTIAL
1547 W. Grand Ave., Pomona, CA 91766
I
TEL: (626) 274-7244, (626) 617-5254
�
Date 20 ;
P.O.
Customer
Delivery Address
Phone #
T.G: -
Amount Due $
PAY: ❑CREDIT CARD CASH D CHECK❑ BILL Driver
40 CU. YD. ROLL -OFF CONTAINER
No Concrete, Dirt, Sand, Asphalt, Brick, etc.
No Hazardous Materials, Tires, Paint, Household Appliance, Batteries and DELIVER [I
Computer, etc. as directed by State/Federal Regulations are accepted in loads REMOVE ❑
Signature _ i
LOW BOY ROLL OFF CONTAINEREXCHANGE ❑,=
®Clean Concrete
❑ Clean Dirt ❑ Bricks/ Rock ❑ Asphalt ❑Sand
Low Boys are designed for the inert materials only: Rock, Concrete, Bricks, Asphalt and clean Dirt
free of Grass and Roots. If Low Boy is contaminated with other material including Trash, Wood
Glass and Metal, etc. contamination charge will be assessed based upon severity of contamination.
Signature
1
�
Q;SERVICE CHARGE
/d 5TON LIMIT
� MUST CALL FOR PICKUP
(Allow 48 hours after box is loaded for remov� unlesso toerwisel agreed on.) -:
We reserve the right to refuse to haul any excessively or incorrect loaded containers.
*All material must be loaded within the container and shall not exceed the top level of the container. 1
*Customer agrees to provide clear access to the container for loading and unloading. If a driver
is required to wait over 15 minutes, and idle charge of $100 will result.
i *An extra charge of $150 will be made for any unnecessary trips due to excessive or incorrect loading. r
*We are released of liability for all damages caused by container and/or truck when providing
service as directed by a customer or their agents.
*Customer agrees to pay for any damage to container while in his/her custody and care.
*Customer is fully liable for lost or stolen container.
*Cancellation must be made at least 24 hours prior to scheduled delivery date, otherwise
cancellation fee of $1 so will result.
*If collection action is required, customer agrees to pay all collection c
*If you don't pay for the dump, we will dump it back. osts including attorneys fees.
Signature X