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STATE COWRACTORS UCENSE#547761 t TRANSPORTATION RECEIPT
<br /> ST
<br /> STATE ID 101"S t WORK ORDER
<br /> DO627
<br /> T 465M 051088
<br /> ISLAND ENVIRONMENTAL SERVICES, INC.
<br /> Waste Management & Transportation
<br /> k a' jj I Established 1982
<br /> 3359 W.POMONA BLVD. • POMONA,CALIFORNIA 91768• (800)400-4347 • (909)598-4449 • FAX(909)59""1
<br /> Contact VENDOR#443393 custom# W16"
<br /> Job Site WAL-MART#1554-STOCKTON � � , Order date WH. OMIX
<br /> 5223 EAST HAMMER LANE
<br /> Address _.. ,..._... Driver ., r-Inw? . Unit#
<br /> STOCKI CA 0=12
<br /> (209)M7M Appointment Date Q�/1�I�p06 77.00:00 Time
<br /> Phone Facility
<br /> REMEDY ENVIRONMENTAL
<br /> OdISAST.
<br /> Hours ..�
<br /> 300 E FR
<br /> EPA ID# t .. , _. S L.;s;{CA _ 92W_
<br /> PO# Appt.Time: Scheduled with
<br /> So
<br /> Salesman - A EPIC JAE4. 0�►6�+
<br /> Bw To 702 S.W.8TH STREtT Ph" au &Z
<br /> BENTONVILLE,AR 11716 «'
<br /> ,lob Descriptleon SOX MONTH SERVICE
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<br /> Driver Notes: U(J
<br /> f Date
<br /> ustomer Si ure ver SigrYaturdTio,b Site)
<br /> ? nt Name Date Driver Signature(Off-Load) Date
<br /> NOTE:THIS IS A MODIFIED MANIFEST FOR THE DISPOSAL OF YOUR WASTE J
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