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ENVIROPUR WEST CORPORATION <br /> ®L X13 �5D) <br /> STATE MANIFEST# <br /> 13331 N. Hwy 33 I P.O. Box 1167 USED OIL HAULER# 86-050 <br /> Patterson, CA 95363 EPA# CAD083166728 <br /> HAZARDOUS WASTE <br /> (209) 892-6742 1 (800) 874-4444 HAULER REG#--?5g1 <br /> C f INV.# 75700 <br /> INTERVAL DATE <br /> wE TP.uCIC r /�1 Cl <br /> CrA. <br /> �e ' ` - T �-�-1---1� <br /> U W E CASH <br /> pILLINe hQDRE55 IF D1 FFEIRENT <br /> T <br /> © t NE DAYS_. <br /> Nit i CITY 9T' E ZIP `� <br /> trT`r TACE LP PHON£ <br /> O# v <br /> Ft , <br /> • PLEASE PAY FROM THIS INVOICE • <br /> PRODUCT <br /> GALLONS HOURS RATE AMOUNT <br /> HAZARDOUS WASTE OIL <br /> TEST FEE <br /> HAZARDOUS WASTE <br /> HOURLY.CHARGES <br /> I certify amount shown above to be correct. c <br /> (Driv r Signa(ure) <br /> (Customer Signature) <br /> PAYMENT DUE UPON RECEIPT OF INVOICE.A service charge of t�%per month shall be charged TOTAL CHARGES `-r <br /> on all past due accounts. In the event this account becomes delinquent and it is necessary to institute <br /> legal proceedings,purchaser agrees to pay reasonable ettomey,s fee and court costs. <br /> FWHITE:C%nlmner CANARY Nphebaticul PINK:Nuff*Hc GOLDENROD;File - -j <br /> ll 'r� RSIN*MPTI _�' <br />