Laserfiche WebLink
please send payment to: MOSLEY <br /> Mosley Environmental Services <br /> p.o-box 57%02 ~ ENVIRONMENTAL BILL OF LADING/INVOICE <br /> Modesto,Ca.95357 - <br /> offtce 1-800-581-7999 SERVICES <br /> fax 1-209-522-5123 wy-# 102400 <br /> cell 1-209-602.6976 <br /> paged CA-209-654-2422 D.T.S.239477 4298 DATE 10-24-03 <br /> C <br /> wnnosley@cs.com <br /> EPA ID# AL000L000259513 <br /> CUSTOMER INFORMATION: SHIP TO: <br /> Name: Stockton Nissan EPA#CAD044003556Greenleaf Environmental <br /> Ramos Fnvoot mental Service O. Box 1765 <br /> 3131 Auto Center Ciltstss.Rw«Rd. <br /> Address: uener rce W-Sa«amento,CA.95691 Lodi, CA. 95241 -1765 <br /> City: Stockton Stote:CA. Zip: 95212 O Cdleclbn station O Agncuhwal Source 0Industrial Oil <br /> Cl Government Source 0 Industrial Source O Lubricating Oil <br /> E.P.A. I.D. #: 0 Marine Source 0 Other <br /> PRODUCT INFORMATION WASTE MANIFEST GALLONSPER GALLON <br /> SERVICE INFORMATION CODE NUMBER QUANTITY PRICE AMOUNT <br /> Used Oil, Non-RCRA Hazardous Waste, Liquid CA221 <br /> Used Antifreeze, Non-RCRA Hazardous Waste, Liquid CA134 <br /> Oil&Water, Non-RCRA Hazardous Waste, Liquid CA223 <br /> ❑ Clor-D-Tett G4000 Test Kit: TeoCl PossO FciIO Generator Knowledge0 PPow - ®�j• 3 <br /> Used Oil Disposal Fee <br /> Other: ; 1 N <br /> Other: E <br /> Other: <br /> Truck Time: <br /> TA CHARGES: i - <br /> e>ErceRAroR•s etRnrluTloN:I Iwraby a.daw rw�n.wnleM.d N.wmy m.m en rulF�as de,a+t.d.bur.4 ,d,I m.end aA dmsX.d,pd.d,mad.d,and lobMd,wd x ae' <br /> raps!x pvper cwdXbn be.ampon M hyMor acca,dna p applkubb w vrd nml«ml W reavlmiau.X I vm o 6 quan' nmbr,I wnRy MI I low a Paarv^`in plow b i.d.M and <br /> bdCiry d ati <br /> V— b M dean.I law <br /> par.wa�bmbbaMb mM.aanidenX.roar Ib wM1n.mvavan dh.eNalmI acverdd oMA dcwdnbure;bMORaa,c.XwmrovrmmmkwvvA•r A vgbw'vvnebTlryMe IvaI e'bdmxMnvbrturp,ohI nahe.oedn oanmblyocdfbed vo MloavcNNopndyolopceRcha M iemaa^brwwrmd,wsr..vwasr.v«Aonduapndawwl l.wamMrdbr a. 0' <br /> RSlodGpde wd oab 6,1 <br /> Transposmt <br /> oamm•pe.mheirXh rn''mvM.MI b <br /> Name: am Mosley <br /> I Iwaby cady R,ol aA xbrmm;or,rvbrnmed b M vnd aA anwh.d dosvmenb can 'cv Ina and aaanx d..c.lpnwv d M r.6.am bbmwebn reaadp knon,a swpectd hvmrde vi6 M vette <br /> M1n ban dbub.ed. 1 qIm wrNr Mr Iml mired Ihu none wiA�errr aMr xms. nd M bbl hol-0u an 4u Mn 1000 crnbmer aanm b pvy wmraW wb ad anvnwy x M voAetlim d <br /> M aloe v. d edam mem d M aWgabn slmA b slanisl county.1 declare under penalty f p«jury that the foregoing is true and cones <br /> Generators Si naturerl Print Name <br /> ADDITIONAL INFORMATION: Pl1R RDER# <br /> ca ba <br /> Customer Billin2 Name <br /> cn sem. zV <br /> Customer Billing Address <br /> ru <br /> CRL PA R <br /> Customer Phone Numbers ( ) ( ) ( ) <br /> Notes: <br /> State Low Requires that you keep this Receipt/Bill of Lading on title no less than 3 years. <br /> To obtain an EPA ID# -Customer mow contact DTSC Ca)916-324.1781 or 1.800.618-6942 <br />