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General Petroleum <br />REMIT TO: P.O. Box 31001-1235 <br />Corporation Pasadena, CA 91110-1235 <br />19501 S. Santa Fe Avenue Customer Service:(800) 659-5823 • Fax: (310) 356-2624 <br />Rancho Dominguez, CA 90221 Credit Inquiries:(310) 356-2400 <br />INVOICE # <br />•• ••CUSTOMER P.O. <br />• <br />DEL. TICorKET # • <br />BILLING ADDRESS: <br />TERMS: <br />ARRIVED LOAD POINT AM DATE <br />_ PM <br />ARRIVED DESTINATION AM DATE <br />PM <br />END GAS DIESEL <br />TANK <br />BEGINNING <br />TANK <br />COMPLETED LOADING AM DATE <br />PM <br />COMPLETED UNLOADING AM DATE <br />PM <br />I WATER DETECTED? <br />❑ YES ❑ NO <br />DRUM DEPOSIT <br />DATE (LOADED/DEUVEREDBY <br />SHIPPED TO: <br />COUNTRY CODE: <br />FOR CHEMICAL EMERGENCY <br />Spill, Leak, Fire Exposure or Accident <br />CALL CHEMTREC - DAY OR NIGHT <br />800-424-9300 <br />FOR COMPANY USE ONLY <br />RT❑ TF❑ OP[:] <br />TIME SPENT LOADING TRUCK # BIL # <br />TIME SPENT UNLOADING <br />TEMPERATURE GRAVITY <br />DRUM CREDIT OUR PUMP <br />❑ YES <br />DATE <br />EXCESS TIME <br />S TD �.4D.' -Z 7, WM 1SCRU AIS PRMRY <br />QAS7,U DESOMW. PA' "D. WMDANDLARLMAWMEN <br />PROPER CWKA FOR TNNb OMTON AIXCfGNNG TO TIE <br />APPUWd FEOUATIONSOF W DEPARTNEW OF TWI PMATM <br />NO W TIE EYFNf OF AFAZ d.OJS 4AT87ALS <br />IIILLRfTCIIl EIEAOEHCYN 14oG 214wc <br />