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General Petroleum <br />REMIT T0: P.O. Box 31001-1235 FOR CHEMICAL EMERGENCY <br />Corporation Pasadena, CA 91110-1235 Spill, Leak, Fre Exposure or Accident <br />19501 S. Santa Fe Avenue Customer Service: (800) 659-5823 • Fax: (310) 356-2624 CALL CHEMTREC - DAY OR NIGHT <br />Rancho Dominguez, CA 90221 Credit Inquiries: (310) 356-2400 800-424-9300 <br />EWM0INVOICE # <br />OR <br />• • • • DEL. TICKET # : • u <br />BILLING ADDRESS' SHIPPED TO: <br />TERMS <br />,':H'27809Dd5S <br />yk1c3Z32SEi�4"�1 <br />GEO Fi1.)A.X LOW ASH 4tT <br />ARRIVED LOAD POINT AM DATE <br />PM <br />ARRIVED DESTINATION AM DATE <br />PM <br />END GAS DIESEL <br />TANK <br />BEGINNING �U+ <br />TANK <br />COUNTRY CODE. <br />4400 6 5 GAL D R I+f _._ _.�._... <br />500.00 bUL K GALS <br />r <br />FOR COMPANY USE ONLY <br />RTO TF El OP El <br />COMPLETED LOADING AM DATE TIME SPENT LOADING TRUCK <br />PM <br />COMPLETED UNLOADING AM DATE TIME SPENT UNLOADING EXCESS TIME <br />PM <br />OTHER WATER DETECTED? TEMPERATURE GRAVITY D.O.T, HAZARDOUS MATERIALS PLACARDS PROVIDED <br />ElEIr SHIPPER CARR�iM <br />YES El No 7HSISTOCgMTHATTHEAB IENMtFDMM64U5RPEPROPE2I <br />DRUM DEPOSIT DRUM CREDIT OUR PUMP <br />gA531FlE0, UESGfBBED. WZVAW MARKED AND U ELFD AND ARE <br />IN PROPER CONCITON FOR TRANSPORATION ACCORDING TO THE <br />AMICABLE HEGlkAT0W DF THE DEFA MENT OF TRNISPONIATNkt <br />El YES ❑ NO N ME MT OFA RAUADOUS MATERIALS <br />C;I I.qT(IMFR (:r)PV <br />