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AMERICAN -L TANK <br /> METAL Nom" 33494 <br /> RECYCLING, INC. TANK DISPOSAL FORM <br /> 2202 South Milliken Avenue Date: 19 <br /> Ontario, CA 91761 Job # <br /> (714) 988-8000 <br /> P. O. # <br /> CONTRACTOR: <br /> ADDRESS: <br /> JOB SITE: <br /> ADDRESS: <br /> DESTINATION: A.M.R. 2202 S. Milliken Ave., Ontario, CA 91761 <br /> DATE TIME PROJECTED TANKS ORDERED By UCNO. <br /> Illy <br /> 3 <br /> TIME IN: q q r� �1 <br /> SPECIAL INSTRUCTIONS: JAN L 1390 <br /> TIME OUT: <br /> ENViRONivic., AL HU LTr;l <br /> PERM FUSEIRV(CE <br /> r Services Rendered Cost <br /> Disposal Fee 200.00 TANKS RECEIVED <br /> CITY. GALLONS TYPE NETTONS TOTAL <br /> Extensive Loading Time 150.00 F'S' <br /> 280 ❑ ❑ .14 <br /> Disposal Fee with Permit 300.00 500 ❑ ❑ .21 a <br /> 550 ❑ ❑ .24 <br /> Fiberglass Tank Disposal Fee Per Tank 400.00 1000.12 ft. ❑ ❑ .44 <br /> 1000.6 ft. ❑ ❑ .61 <br /> Fiberglass Tank Delivered 200.00 1500 Cl ❑ .87 <br /> 2000 ❑ Cl .97 <br /> Bobtail Disposal Fee 250.00 2500 ❑ ❑ 1.143000 ❑ ❑ 1.32 <br /> 4000 ❑ ❑ 1.64 <br /> r`anrPllat'on FPP _ _250,00 5000 El .Q 2.42 <br /> 6000 ❑ ❑ 2.84 <br /> TOTAL CHARGES $ -0-=- 7500 ❑ ❑ 3.26 <br /> 8000 El El 3.44 <br /> 9000 ❑ ❑ 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 ❑ L7 4.93 I <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. <br /> CONTRACTOR'S SIGNATURE 'F — FIBERGLASS ,�-'S'=STEEL 105 <br /> CERTIFICATE OF TANK DISPOSAL 1 DESTRUCTION d{!I <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. J <br /> RUTH DATE <br /> BILLING COPY <br />