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2. Date and Time*
   Date and Time

   Date and Time
4. Company*
6. Driver's Name*
7. Contact Phone Number*
9. Gallons*
10. Origin*
11. PH Result*
13. Contents*
    -- Select One --Port-a-PotLandfill LeachateResidential Septic Waste
15. Please upload a photo of pH results*
17. All loads must be within a specified pH range of 6.0-9.0. Should testing indicate a pH outside of this range it will not be accepted.
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19. 1. Receive an email copy of this form.
20. Email address

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21. Submit

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