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RECEIVED <br /> J U L 2 5 1991 <br /> ENVIRONMENTAL HEALTH <br /> PERMLT/SERVICES <br /> (7UAMNERICAII IEL TANK <br /> M� <br /> No. `' ' Z! 7.. <br /> RECYCLING, In'C. TANK DISPOSAL FORM <br /> 2202 South Milliken Avenue Date: X19 <br /> Ontario, CA 91761 Job# <br /> (714)988-8000 <br /> - PCO. # <br /> CONTRACTOR .."_ <br /> rvc/ <br /> ADDRESS: v^ <br /> JOB SITE: f! <br /> 1,/— t�X��1 •e <br /> ADDRESS. !. ^..- <br /> J <br /> DESTINATION: A.M.R. 2202 S. Milliken Ave., Ontario, CA 91761 <br /> DATE TIME PROJECTED TANKS ORDERED BY: LIC.NO. <br /> TIME IN: <br /> SPECIAL INSTRUCTIONS: <br /> TIME OUT: <br /> vo Services Rendered Cost <br /> Disposal Fee 200.00 TANKS RECEIVED <br /> QTY GALLONS TYPE NET TONS TOTAL <br /> Extensive Loading Time 150.00 F"S* <br /> leo ❑ ❑ <br /> _ Disposal Fee with Permit 300.00 �.4"��.����Sapp� �<�. �'�cQ � F, 14 <br /> rglass Tank Disposal Fee Per Tank 400.00 —Q ❑ u <br /> A ❑ "� <br /> 1000 6 R ❑ ❑ � <br /> Fiberglass Tank Delivered ! �!!• «.=----�—.« 1300.wr :� « r. L3 Cl<.._ SF, J17. <br /> �'------. 2000 r,R ..�..�.F ❑ ❑ _x 97. <br /> Bobtail Disposal Fee 250.00 « ,> _ >= t1rA,r> 114: <br /> 3000 <br /> .. .. 4000 r�...t s > <br /> Cancellation Fee 250.00 sp00 a ❑ ❑ 242 <br /> TOTAL CHARGES $ �.N .1 :..Z .u.: ❑ ❑ as �.>.. Zea <br /> ❑ ❑ 328 <br /> R3.82 <br /> All fees incurred are per load unless specified. rEMMZMI0000n <br /> Terms are net 30 days from date of invoice. 12000 <br /> Contractor's signature represents acceptance ❑ 4.93 <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— Flf3ERGLASS `S— STEEL 105 <br /> r <br /> CERTIFICATE OF TANK DISPOSAL/DESTRUCTION <br /> THIS IS TO CERTIFY TH IPT AND ACCEPTANCE OF THE TANK(S)AS SPECIFIED ABOVE.ALL MATERIALS SPECIFIED <br /> �MPLETELY DESTROYED FOR SCRAP PURPOSES ONLY. <br /> S- le W <br /> AUTHORIZED REP. DATE <br /> CONTRACTOR COPY <br />