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All- -v'- Transportation & Remediatir Inc. I r U- i <br /> �Environmental Services <br /> A Hazardous Waste Transport tion Benrc.a,CA Phoenix,AZ San Ardo,CA San Martin,CA PO" <br /> Awa A Hazardous Materials Management 7071746-8287 6021252-1186 408/627-2595 408/683-0447 DATE: G Z ^�— <br /> ♦General Engineering Construction <br /> TIPPER CONSIGNEE t �� <br /> ADDRESS ADDRESS <br /> CITY CITYL <br /> CONTACT CONTACT <br /> CUST. PHONE CUST. PHONE <br /> SPECIAL EQUIP. (FORKLIFT,PLACA DS,ADD'L STOPS.ETC.) MANIFEST NO. <br /> INSTRUCTIONS:' /J <br /> QTY. HAZ DESCRIPTION WT HRS MILES RATE AMOUNT <br /> I <br /> BIN INFORMATION <br /> � J,3 Dropped Off Picked U <br /> DRIVER TRK c J TLR <br /> NAME: 41� r� c4 TL-c.d-- NO.: _�—�<< � NO,: ZJ 7 <br /> GINNING TIME: A RIVAL TIME: I / ARRIVAL TIME: <br /> LOADING TIME:(START) (STOP) r �D UNLOADING TIME: (START) (STOP) <br /> LEAVE SITE: <br /> PAPERWORK DELAY <br /> LEAVE SITE: ENDING TIME: <br /> SIGNATURE: j RECEIVED BY: <br /> TERMS: Net 30 days.Consignee to pay any I i l let s for collection of delinquent accounts,plus the legal rate of interest of 11h.,per month or 18%per year will be charged for all past due accounts. <br /> We make all deliveries inside curb and on Ic t at customer's risk only and accept no responsibility for damages resulting from such deliveries. <br /> Claims for short or damage or overcharge rr ust be filed with this receipt within 10 days. <br />