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MOSLEY ENYIROMENAL 20SS225128 01/19/04 0SISBPm P. 002 <br /> GREENLEAF ENVIRONMENTAL tFRVTCC 8,U%l OF LffING # 'frJ.4037 <br /> P_C_ Box 1765 EPr, NUMB-:R CALOOOU63781 <br /> LODIr CA. 952A1--f765 <br /> ............ <br /> PICK-UP 0A TE <br /> C I-IMAME WURT gwi <br /> 1) '5�cx-r"' <br /> F �ADDRESS r E wvs <br /> 0 il 7--,I <br /> �'A <br /> C' CjT-Y �-�l A7 F ZAL KTNGS, CA, SPHONE <br /> R '15 52 <br /> .JPRODUCT PiRl C E 4KOUNT <br /> 111]1111.11.4 .1 z I V 'X, 1.� 1 1 <br /> JORAINED USED OIL FILTERS 55 W DR';,; <br /> IOTL A13SORSa. ENT MATERIAL 55 GL DR <br /> in <br /> FP-1 <br /> jMISC EMPTY DRUM SC44,-4 ' MEI �L <br /> 21 <br /> iMISC EMPTY DRUM PLAST7L. <br /> DROP CUST DRUMS NE" ACCQUW� <br /> � <br /> UNCRUSHED CRUSHED <br /> EMPTY <br /> ti <br /> tl <br /> i AL-�lwl lgirl$d PILWIIT4'", <br /> CHARGES <br /> P�l <br /> , I <br /> 1 CERTIFY THAT THE lHFCRMATTPW AND THE AlOWS SWORM WOVE ARE TRUE AND <br /> CORRECT, AMO THAT WC 05W 77! 7 r 3L v: 7W"0F5 75 GRYENLEAF ENWRO SERV <br /> MEETS THE DEFINITION OF US:, U Q 1; QT 1, PS «'. TO HEALTH <br /> AND SAFETY GOVE SECTION 25250 . , kWNES UTHERWSE NOTED, THIS FURTASR <br /> SERVES AS VOTIFICATIOM jHAT WE POeVI MA37I IS 0ANNED FROK LAND DISPOSAL <br /> PERSUANT TO SECTION 66260.010) OF QYLE2l. 1 ALSO ACKMOWLEDGE THAT I <br /> HAVE READ AND AGREE TO TME TERMS qtRr VW0wQWW SET FOPT" O-'j Tt4113 FORn. <br /> 4 <br /> DRIVES' SIGNaTURP DATE DA7E <br />