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Dec 18 10 06:19p TDR 81 WRW 5032401992 p.2 <br /> PLEASE REMITSO: <br /> TPIL) 10113974 P.c). I(oc 793336 <br /> LOCATION =: ,_. S' <br /> _�� ���� ;��ae: � I°r7rrlan[1,OR 9. l <br /> 4106 i�. -Ico R<na :'sF_� :c: .: �• Z.A77-C)1 il-"ryRF. <br /> t.ivecmi rc, GA 9i653 , X4,_097"? rpSTE RECOVERY WEST, "'C- <br /> 0 -IIC, t� 1 'End Usc Facility <br /> Livcrmocc& Sacra,r.cnco rca (9�>�� 'HaulcJ t. !"jl'ickuv <br /> RcddingArez ;S�O) 3i� 1t6U 1.-' _� Phoned iFSdi.cy <br /> I Q Load Date <br /> Invoice Dat2_�I `—�- � Acct ii___�___�------9------�—C-- <br /> Customer Name104kFtale�l1 <br /> Site Street AddCity cess� <br /> �,i�� i a.je,Il:el.wso(iu Sntc ui 131i:):rp-hn rttek,h�rtn:u uo lrr•t �,uon uew.+*n.Y„t•G.Kcu•or.r:Crtill)',b:[rrt1r1 7••rcri ury u4iro n:pmsi.x,.:r.Vr�LLort.Q"dcn:�l o�[cn<+abhhc Vl'orn"Lr�Fi unci 9i=r rl 7 <br /> r Acscri'Micd r�.�.,lPl�Fbislia:6o,rranµr..cn.,r..y rra, �lger[al•.Per.;dxi:,::or✓tm;n.•n, Kfx!i'J.rvtur'1l2 <br /> mw.l_ <br /> ._.F+_C tom <br /> :rP' tl tics wS'Q <br /> aotperuaupto55,OPu <br /> DRIVE v --it <br /> ouc w���r.{�9(. 16—luC _. <br /> _. <br /> t t ca RCS <br /> iRLR/' YEFI.FLP fl <br /> TA V ' rEIP LOU 0 <br /> i0.IICK 19 JLE NIPORI LOCA-ION G S -Wc / t7+ <br /> E OE L LIC 5 "E <br /> 1 EXPOP.T OIyPEAmount <br /> Desc+iplion -Y-P Rave <br /> L7A�AM DU„7 133 , <br /> Y y <br /> Total r,rncU11t$ <br /> Customer Signature y r 2 ' 34 <br /> _ fi<la'rs ni dre�u:roi<:+11wx„o,h,:Ibe inicxlluaon praideA o6u�e:c rr:,e.nJ:n^cc' - J <br /> �, ,r Iihl� IurJO^rnllR'OlPrrpWY �r = . ;'hu� ,�. INVOICE c <br /> �e i_ = <br /> pJJrtirnl.I>m wart lila l:wn:ua`^nlri:u,r,..,:.ai:uy rout,En_iril Pc nalecr,iP.,3_a 17C pr - Pc <br /> Pcn+11in up Vol".. I<c, <br /> Electronic R"i-ting to CIVYMB: WRW has been authorized by CIWMB to participate <br /> Ln <br /> in the Waste anti Used Tire Maniifet;t EDT electronic rerx)riin-pm rain. On behalf J1'the <br /> ctt,tornerIisted oil this form. WR\V NN-111 elecironi:al1v ccansmit to CINVNIB all required <br /> infonnatioll from this manifest form when WR«' is acting as hauler and I's So mark-elf on <br /> tt,e froth of chis Conn. <br /> Confidentiality Clairn: -file laform;ttion provided on Illi; fern should be considered <br /> contiilenti:Ii_ proprieclry, and/or trade ,ccret. h1 accordance with Title 14p CCR,S+rctioli <br /> 17041el.seq, yhouhi any memberof Hie public request disclusure of this infonnuiioa. I <br /> request that CIWNIB coni-acl mc. at the address and tck;phone number on the from of this <br /> form. <br /> C = Count <br /> T = Tons <br /> Y = Cubic Yards <br /> P = Pounds <br /> d d0,Eo O L lC oe4 <br />