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A ,A FUEL TANK bp <br /> N <br /> MERIC No :1 <br /> METAL . <br /> LING, INC. TANK DISPOSAL FORM <br /> '1971 <br /> date e: i <br /> 1 2202 South Milliken Avenue <br /> ly ea(ch tank <br /> Ontario, CA 91761 Job # i <br /> ined to San <br /> (714) 988-8000 P. O. <br /> # r, <br /> P. 0. # �a I <br /> Is i b 1(-2 ci r <br /> CONTRACTOR <br /> ADDRESS: <br /> JOB SITE <br /> —ADDRESS: <br /> DESTINATION: A.M.R. 2202 S. Milliken Ave., Ontario, CA 91761 <br /> ORDERED BY: <br /> DATE TIME <br /> TIME IN: <br /> SPECIAL INSTRUC11ONS: TIME OUT <br /> 371py <br /> II <br /> TANKS RECEIVED <br /> 11 TYPE NET TONS TOTAL *t It <br /> QTY GALLONS 11 F*S* <br /> ❑ .14 <br /> .280_ <br /> 21 <br /> 55 _ .24 <br /> Aqo�-12 <br /> 4 / <br /> CID w 5DO <br /> M jw -.: .. .1. .1. .. .. . . <br /> 20M <br /> 132 <br /> T <br /> T <br /> 0 <br /> .N <br /> 2 <br /> 2 <br /> 4 4 <br /> 1 <br /> 4 <br /> 4 <br /> 1 <br /> 7 <br /> _4 <br /> 3 2 <br /> 4 <br /> 64: <br /> 7-7—_,� �s been <br /> �40DD <br /> 24z <br /> 1�erviices. <br /> 164 <br /> 3 6 <br /> .26 <br /> O 3" <br /> 7560 0 ID 4 <br /> 3.'2 <br /> 3.8i <br /> 4.33 <br /> 7— <br /> All tees incurred are per load unless specified 4.93 <br /> 12000 ❑ 0 <br /> Terms are net 30 clays from date of invoice. <br /> Contractor's signature represents acceptanceTOTAL I NET TONS <br /> nd confirms that tank No.OF TANKS <br /> of terms for payment a <br /> removal complies with state laws <br /> -F — FIBERGLASS TEE <br /> CONTRACTOR'S SIGNATURE <br /> CERTIFICATE OF TANK DISPOSAL I D ESTRUCTIO N I ATERIALS SPECIFIED co 1� <br /> E.OF THE TANK(S►AS SPECIFIED ABOVE.ALL M <br /> , YxTHE RECEIPT AND ACCEPTANC �R SCRAP PURPQS�ES ONLY. <br /> THIS IS TO CF EN COMPLETELY DESTROYED FOR EB <br /> DATE <br /> AUltiuKut-ED REP. <br /> GENERATOR-COPY <br /> AUTHORIZED SIANDAND TITLE <br /> Elf 23 049 12168 <br /> MAILING INSTRUCTIONS: MLD IN HALF AND STAPLE. =IX PROPER POSTAGE. <br /> SAN JOAOUIN LOCAL WEALTH DISTRICT <br /> ATIV, UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 <br />