Laserfiche WebLink
06/26/2003 THU 07 47 FAX 661 393 3834 NP ENVIRONMENTAL-BAK 0003/012 <br /> N� 10987 <br /> GOLDEM STATE METALS, INC. TANK DISPOSAL FORM . <br /> P C pox 70158 - 2400 E Brundage Lana Data !1 <br /> BaKertfield, C8010mla 93387. 1 V �" <br /> + Phone (805)327-3559 • Fax(905)327x749 Contractor's <br /> Scrap Motals Processing&Recycling <br /> License No � <br /> Contractor's <br /> Phone No <br /> C4NTflACTDfT <br /> ADDRESS <br /> JOB SITE. '� 1 [r l�-a — I L <br /> ADDRESS I Z' 1 C�• � <br /> DESTINATION. G S M • 2000 E.BRUNDAGE LANE • BAKERSFIELD,CA 93387 <br /> —7HAULIER- ! O r) LICENSE NO. <br /> WEIGHT CERT NO:-4-- 1-1 <br /> 0 TANKS RECEIVED EHSD PERMIT NO- OTY GALLONS SERIAL NO NET TONS TOTAL <br /> 250 14 <br /> COUNTY. QR t� <br /> 550 r .24 <br /> SERVICES RENDE RED COST0X <br /> 1040.6ft 8i <br /> 1 TANK INSPECTION aR �` <br /> 2400 97 <br /> [�CLEAN &DRY(ACCEPT),ORWli,y "Io4 <br /> RESIDUALS PRESENT(REJECT) 3000 132 <br /> LEL RFADkMG 6000 242 <br /> OXYGEN CONTENT 7500 328 <br /> DISPOSAL FEE eoaa 242 <br /> SCRAP VALUE <br /> i28o 493 <br /> OTHER <br /> TOTAL <br /> All fees incurred are per load unless specified Terms are �f <br /> net SO days from receipt of tank Contractor's signature <br /> representsaecapta nee of terms for payment,and confirms 1 <br /> that tank removal comp Ile a with State laws. <br /> R � je <br /> 13 Hi yybyq } <br /> CONTRACTOR SfGNATUIt <br /> CERTIFICATE OF TANK DISPOSAL/ DESTRUCTION Y w <br /> THIS 15 TO CERTIFY THE RECEIPt •AND ACCEPTANCE OF THE TANK(S)AS SPECIFIED ABOVE ALL MATERIAL SPECIFIED WILL HE COMPLETELY <br /> �DEST DYED FO SCRAP REG LI G PURPOSES ONLY <br /> ' � <br /> A&W0FiZE REP DATE <br />