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M4 «s : 32158 <br /> �"Inviro-tec n <br /> 011SPaSAL-"In. <br /> YRG Alfiens Avenue•Lincoln,CA 95648•Bus:19161434-0395!Falc[916}3344440, - M Estimated' ,} <br /> Gallons �! <br /> AULER COMPANY �-1 TIME IN TIME OUT MEASURING MELI160 DISPOSAL DATE X30 <br /> DRIVER NAMECt# X MATH RECEIVED BY <br /> AULER ADDRESSr???? . <br /> C)SITEGLA55 <br /> T'RUCK/CARD N . <br /> )FA DECAL R TRUCK LICENSE M�j.,J n 77 p' [I.OTHEP <br /> 7Jj4j/f4�,,7( Qf <br /> SITE ADDRESS CING <br /> fCOUNTY �p 0P(orrtabie Tokt <br /> JSTOMER NAME wry M1..w ALI�NS .� <br /> f7 ❑Septi[ <br /> � /// ❑Grease <br /> ATE PUMPED <br /> TIME PUMPED CUSTOMER NAME CUSTOMER SIGNATURE Other <br /> JSTOMER NAME SITE ADDRESS CITY/COUNTY GALLONS f]Portable Toilet <br /> O Sephc <br /> ❑Grease <br /> ATE PUMPED TIME PUMPED CUSTOMER NAME CUSTOMER SIGNATURE ❑Other f <br /> ISTOMER NAME SITE ADDRESS CITY/COUNTY GALLONS ❑septicFortaYoileF <br /> - � ❑k(ease <br /> ATE PUMPED TIME PUMPED CUSTOMER NAME - CUSTOMER SIGNATURE ♦ � O Other <br /> CITY/COUNTY GALLONS O S€ p able Toilet <br /> 1STOMER NAME SITE ADDRESS <br /> ❑Grease <br /> ATE PUMPED TIME PUMPED CUSTOMER NAME CUSTOMER SIGNATURE ❑Other 1` 1 <br /> lereby cerrify that the above information Is true and correct to ttle'best of my knowledge,and further certify that the materials delivered to Inviro-Tec Disposal.,LLC at this time f <br /> �ritain only those materials listed above and as certified In the customer certification directly above,and to the best of my knowledge,contain no hazardous waste as defined by the TOTAL GALLONS <br /> P.A. <br /> RIVERS SIGNATURE <br /> PRINT NAME <br /> DATE <br />