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01/26/2019 00: 46 FAX Z003 <br /> DATE 02/25/11 <br /> CUSTOMER ,APPLIED REMEDIATION INC. <br /> IFB ITEM CONTRACT NO. SCRAP TIRES <br /> VEHICLE TYPE VAN/Trailer LICENSE NO STATE <br /> DIGITAL WEIGHT INDICATOR $ PRINTER TICKET <br /> lbs. GROSS <br /> �� r,c. i•,' 7 7� fn Q�/ ► Ibs. TARE <br /> '♦ <br /> lbs. NET <br /> WEIGI ITMASTERS INITIALS/DATE DRIVER ON <br /> OF <br /> CUSTOMER/AGENT/DATE PASSENGER ON <br /> OFF <br /> WEATHER: SNOW RAIN <br /> REMARKS <br /> SHIPMENT RECEIPT/DELIVERY PASS (Prescribing Authority: DRMS-1 4160.14, Sec. 2, Ch. 6) <br /> 1. 1 O'. PURCHASER OR AGENT Mime of Cerricr, i(Applicoble) 2. FROM (Name and Location of Acriviry and lnstallutlon Frorn Which <br /> AI'1'1.lI:D RHMEDIATION INC, Proporry is being Removed) <br /> 1376 N.4'I'I I -S SUITE 203 DLA DISPOSITION SERVICES SAN JOAQUIN BLDG. 286 <br /> SAN ,LOSE:.CA, 95112-4713 P. O, C.BrigFs Ogamba408-569-2332 FRENCH CAMP,CA 95231 P. O_C. Al Sanders(209)982-2058 <br /> 3. INVITATION NUMBER 4. CONTRACT NUMBER <br /> 5' ITEM B' DESCRIPTION OF MATERIAL 7. 8. QUANTITY <br /> UNIT <br /> RELEASED <br /> SCRAP 'r1R13,5 LB <br /> 9 SHIPMENT NUMBER9A. "K"TYPE OF SHIPMENT 10. TIME LOADED 11. VEHICLE LICFNSE NO. <br /> PARTIAL a FINAL <br /> 12. RELEASED BY (Signurure R U or Aurh rized Repr onrsrive) 13, TITLE OF AUTHORIZED DISPOSAL REPRESENTATIVE <br /> RELEASING PROPERTY <br /> AI. SANDF'IRS SCRAP P.O. C. <br /> 14. SIGNATURE OF U ASER R GENT 1 S. 'DATE PROPERTY IS RELEASED <br /> 02/25/11 <br /> TO 6F OMPLETED BY SECU7t7TY PERSONNEL ONLY <br /> 15, TIME SHIPMENT LEAVES INSTALLATION 17. SENTRY'S INI'T'IALS <br /> DRMS FORM 1367, AUG 2004 (EF) <br /> I <br />