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San Joaquin Co. HHW <br /> IeanHarb, South R.A. Bridgeford St <br /> Stockton, CA 95206 <br /> Telephone(209)468-5670 <br /> ERVIRORMENTAL SERVICES' Fax:(209)468-5672 <br /> INVOICE I AUTHORIZATION.FOR CREDIT CARD BILLING <br /> Date: 5/13/2010 <br /> To: Clean Harbors Environmental Service Job#: Aj2869220 <br /> Fax: <br /> Phone: 781-792-5249 <br /> From: Name: Dave Carmichael Account Number: <br /> Company: Allied Waste Telephone: 209-547-7524 <br /> Mailing Address: 1145 West Charter Way Fax 0 <br /> City/State: Stockton Ca 95206 <br /> This is authorization to pay the following Clean Harbors invoices: <br /> Invoice Number Date Amount Invoice Number Date Amount <br /> SIC 5/13/10 $112.00 <br /> Total Charges to be applied to credit card will be for the following amount: $112.00 <br /> VISA ❑ MASTERCAREM AMERICAN EXPRESS INVOICE ❑ CHECK ❑ <br /> PIN#:1 I CHECK# <br /> If yes, what is the amount?$ <br /> Name as it appears on Card: Dave W Carmicheal <br /> Company Name: <br /> Card Billing Address: 1145 West Charter Way <br /> Stockton Ca 95206 <br /> Credit Card Number: 4807 1000 5062 5875 <br /> Card Authorization Date: Nov-13 <br /> Authorization Signature: <br /> RETURN RECEIPT BY: FAX 0 U.S. MAIL <br /> 1145 West Charter Way <br /> Stockton Ca 95206 <br />