Attachment A - Leachate Hauling PerTrip Load Receipt.pdf

This is a leachate hauling load receipt form utilized by the Cowen Public Service District in Webster County, West Virginia, under the Landfill Closure Assistance Program. The document serves as a per-trip load receipt for leachate hauling services to the Webster County Landfill located in Cowen, WV 26206. The form captures essential operational data including the total gallons of leachate delivered, the date and time of delivery, and identification of the driver and receiving representative through signature and printed name fields. The form includes a reference number (E023242) for tracking purposes and clearly identifies the Cowen Public Service District as the responsible entity.

This receipt form establishes the documentation framework for monitoring and recording individual leachate hauling trips, enabling the service district to maintain accurate records of waste management activities and volumes processed through the landfill facility. The standardized format ensures consistent data collection across multiple hauling events and provides accountability through dual signature verification from both the delivery driver and the receiving representative at the landfill site.