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DATE Aug 22,2012 <br /> CUSTOMER APPLIED REMEDIATION <br /> IFB ITEM CONTRACT NO. 13$4651-01 <br /> VEHICLE TYPEVAN LICENSE NO P288039 STATE IN. <br /> DIGITAL WEIGHT INDICATOR&PRINTER TICKET <br /> 54820 'Do Ibs.GROSS <br /> 32080 "® Ibs.TARE <br /> ♦ 22740 410 Ibs.NET <br /> WEIGHTMASTER51NITIALS/DATEA5 -^ DRIVERON OFF 0 <br /> CUSTOMER/AGENT/DATE PASSENGER ON OFF <br /> WEATHER: SNOW RAIN <br /> REMARKS <br /> SHIPMENT RECEIPT/DELIVERY PASS (Prescribing Authority: DLA Disposition Services Instruction 4160.14, Sec. 2, Ch. 6) <br /> 1.TO: PURCHASER OR AGENT (Name of Cartier,if Applicable) 2.FROM: (Name and location of Activity and Installation from which property <br /> is being removed) <br /> APPLIED REMEDIATION DLA DISPOSITION SERVICES 700 E. ROTH RD. FRENCH <br /> 1376 N. 4TH ST. STE 203 CAMP, CA. 95231 <br /> SAN JOSE, CA. 95112 <br /> 3.INVITATION NUMBER 4.CONTRACT NUMBER <br /> 5. ITEM 6. DESCRIPTION OF MATERIAL 7' UNIT 8. QUANTITY <br /> RELEASED <br /> 1 SCRAP TIRES LB 22740 <br /> 9. SHIPMENT NUMBER 9A. "X"TYPE OF SHIPMENT 10. TIME LOADED 11. VEHICLE LICENSE NO. <br /> Fj PARTIAL a FINAL I i <br /> 12.RELEASED BY (Signature PD rAuthori Representad 13.TITLE OF AUTHORIZED DISPOSAL REPRESENTATIVE <br /> ! RELEASING PROPERTY <br /> AL SANDERS �.�` � SCRAP P.O.C. <br /> 14, GNATU OF CHASER OR AGENT IS. DATE PROPERTY 15 RELEASED <br /> f�1 08/22/12 <br /> YYY��• TO BE COMPLETED BY SECURITY PERSONNEL ONLY <br /> 16. TIME SHIPMENT LEAVES INSTALLATION 17. SENTRY'S INITIALS <br /> DLA DISPOSITION SERVICES FORM 1367,AUG 2004 <br />