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A>..rE�C FUEL TANK 3`s- , A <br /> METAL �. No. (� <br /> RECYCLING, INC. TANK DISPOSAL FORM <br /> 2202 South Milliken Avenue Date: ` 19 <br /> Ontario, CA 91761 Job # <br /> (714)947-2888 P. O. # <br /> CONTRACTOR: ,� f <br /> ADDRESS: - n <br /> JOB SITE: ! ;II _ \ ;-r , 'tY ! <br /> ADDRESS: <br /> U C1 <br /> DESTINATION: A.M.R. 2202 S. Milliken Ave., On ario, CA 91761 _ <br /> DATE TIME PROJECTED TANKS ORDERED 9Y: LIC.NO <br /> TIME IN: - <br /> SPECIAL INSTRUCTIONS: TIME OUT: <br /> T�Q TANKS RECEIVED <br /> B Dry. GALLONS TYPE NET TONS TOTAL <br /> F•S• <br /> 1 280 ❑ ❑ .14 <br /> T �0 13s' .21 r !X <br /> —F— 551 ❑ ❑ .24 <br /> 1000-12 f1. ❑ ❑ .44 <br /> 1000-6 ft. ❑ ❑ .61 <br /> 1500 ❑ ❑ .87 <br /> • Q2000 <br /> ❑ LI97 <br /> �. 2500 114 <br /> ❑ ❑ <br /> 3000 1.32 <br /> 4000 El 1:11.42 <br /> .42 <br /> I illAj r{� + 6500 0 Cl0 2.84 <br /> 7500 ❑ ❑ 3.26 <br /> I 8000 ❑ ❑ 3.44 <br /> 9000 LI El <br /> All fees incurred are per load unless specified. 10000 ❑ El 4.33 <br /> Terms are net 30 days from date of invoice. 12000 ❑ ❑ 4'93 <br /> Contractor's signature represents acceptance TOTAL NET TANS <br /> of terms for payment,and confirms that tank NO..,OF TANKS <br /> removal complies with State laws. <br /> -F — FIBERGLASS 'S—STEEL 105 <br /> CONTRACTOR'S SIGNATURE <br /> CERTIFICATE OF TANK DISPOSAL 1 DESTRUCTION <br /> THIS IS TO CERTIFY THE RECEIPT AND ACCEPTANCE OF THE TANK(S)AS SPECIFIED ABOVE.ALL MATERIALS SPECIFIED <br /> ,HAVE BEN MPLETELY DESTROYED FOR SCRAP PURPOSES ONLY. r <br /> DATE <br /> AUTHORIZED PEP. <br /> GENERATOR COPY <br />