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GREENLEAF ENVIRONMENTAL SERVICE BILL Or LADING # HT11230 <br /> P.O. BOX 1765 EPA NUMBER CAL000163781 <br /> LODI , CA. 95241-1765 <br /> (209) 754-4600 <br /> PICK-UP SHIP TO: DATE <br /> C NAME OUST NO_ <br /> U FREIHS AUTO REPAIR GREENLEAF ENV. SERV 09- <br /> i ADDRESS TERMS <br /> M ACK DIAMOND WAY 3474 TOYON CIRCLE <br /> 0 :916 BLACK <br /> E CITY STATE ZIP VALLEY SPRINGS, CA PHONE (209) <br /> R LODI ACA 95224040 95252 369-9660 <br /> CUSTOMERS PO# <br /> PRODUCT PRYCC AMOUNT <br /> DRAINED USED OIL FILTERS 55 GL DR "� G 55.00 <br /> MOIL ABSORBENT MATERIAL 55 GL DR <br /> FP-1 <br /> MISCEMPTY T'f DRUM „CRAP METAL ���i .����_„- _ i <br /> . _ t <br /> MISC EMPTY DRUM PLASTIC � /� ru <br /> DROP OUST DRUMS NEW ACCOUNT <br /> _ DEC 2 2 2003 <br /> CRUSHED UNCRUSHED EMPTY <br /> N1'SSUi.VfVIENT HEALTH <br /> RPaI /SERVICES <br /> .TOTAL <br /> CHARGES -� <br /> I CERTIFY THAT THE INFORMATION AND THE AMOUNTS SHOWN ABOVE ARE TRUE AND <br /> CORRECT, AND THAT THE USED OIL FILTERS PROVIDED TO GREENLEAF ENVIRO SERV F <br /> MEETS THE DEFINITION OF USED OIL FILTERS PURSUANT TO CALIFORNIA HEALTH <br /> AND SAFETY CODE SECTION 25250. 1 , UNLESS OTHERWISE NOTED. THIS FURTHER <br /> SERVES AS NOTIFICATION THAT THE ABOVE WASTE IS BANNED FROM LAND DISPOSAL <br /> PERSUANT TO SECTION 66268. 7 (10) Of title 22. I ALSO ACKNOWLEDGE THAT I <br /> HAVE READ AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THIS FORM. <br /> t <br /> l<£1 <br /> DRIVERS SIGNATURE DATE '6'ENERATC-'O'S SIGNATURE DATE <br />