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A <br /> y AMEBIC:Lr-�FUEL TANK /�� n Q �j O n <br /> ETAL �./ `%. L o J G <br /> y CYCLING INC. TANK DISPOSAL FORM <br /> i[j 9 South Milliken Avenue Date: <br /> 1i JAS rio, CA 91761 Job # <br /> 11WA41;12888 <br /> ENVIPRERMR gE ICES R O. # <br /> CONTRACTOR: <br /> ADDRESS: <br /> JOB SITE: <br /> I <br /> ADDRESS: - '} <br /> DESTINATION: AAA 2202 S. Milliken Ave., Ontario, CA 91761 <br /> DATE TIME PROJECTED TANKS ORDERED BY: LIC.NO. <br /> TIME IN: <br /> SPECIAL INSTRUCTIONS: TIMEOUT. <br /> r Services Rendered Cost <br /> Disposal Fee 100.00 TANKS RECEIVED <br /> OTY. GALLONS TYPE NET TONS TOTAL <br /> Extensive Loading Time 150.00 F' 9- <br /> 280 ❑ ❑ .14 <br /> _ Disposal Fee with Permit 250.00 500 ❑ ❑ .21 <br /> 550 ❑ ❑ .24 <br /> _ Fiberglass Tank Disposal Fee Per Tank 400.00 1000-12 ft. ❑ ❑ .44 <br /> 1000 6 ft. ❑ ❑ .61 <br /> Delivered 200.00 1500 ❑ ❑ '87 <br /> 2000 ❑ ❑ .97 <br /> Bobtail Disposal Fee 250.00 2500 ❑ ❑ 1.14 <br /> 3000 El Cl 1.32 <br /> Z 4000 C:E7 1.64 C- <br /> Cancellation Fee .J250.00 5000 ❑ ❑ 2.42 <br /> 6000 ❑ ❑ 2.84 <br /> TOTAL CHARGES $ 472 7500 ❑ ❑ 3.26 <br /> 8000 ❑ ❑ 3.44 <br /> 9000 Cl ❑ 3.82 <br /> All fees incurred are per load unless specified. 10000 ❑ ❑ 4.33 <br /> Terms are net 30 days from date of invoice. 12000 ❑ ❑ 4.93 <br /> Contractor's signature represents acceptance <br /> of terms for payment,and confirms that tank NO.OF TANKS TOTAL NET TONS <br /> removal complies with State laws. + 1, <br /> /i J J <br /> CONTRACTOR'SSIGNATURE -F — FIBERGLASS 'S—ST EEL 105 �� <br /> CERTIFICATE OF TANK DISPOSAL I DESTRUCTION <br /> THIS IS TO CERTIFY THE RECEIPT AND ACCEPTANCE OF THE TANK(S)AS SPECIFIED ABOVE.ALL MATERIALS SPECIFIED <br /> HAVE,BEEN/COMPLETELY DESTROYED FOR SCRAP PURPOSES ONLY. <br /> AUTHORIZED REP. DATE <br /> CONTRACTOR COPY <br />