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AMC+RICAN FUEL T-NK <br /> METAL �. No. , 33494 <br /> RECYCLING, INC. TANK DISPOSAL FORM <br /> 2202 South Milliken Avenue Date: 19 <br /> Ontario, CA 91761 o <br /> (714) 988-8000 Job # <br /> RO. # <br /> CONTRACTOR: <br /> KTON �►t R�C'TT► 13 GR P rt. <br /> ADDRESS: <br /> J06 SITE: CA. 9,5205 <br /> O__ ('Rp�clFriR� CQ. <br /> ADDRESS: 0 r <br /> ���eex a1 <br /> DESTINATION: A.M.R. 2202 S. Milliken Ave., Ontario, CA 91761 N 2 5 19SO <br /> DATE TIME PROJECTED TANKS ORDEREDeY: lIC3+R1\/ MENTAL HEALTH <br /> TIME IN: <br /> SPECIAL INSTRUCTIONS: <br /> TIME OUT <br /> v6� <br /> r Services Rendered Cost <br /> Disposal Fee 200.00 TANKS RECEIVED <br /> Of Y. GALLONS TYPE NETTONS TOTAL <br /> Extensive Loading Time 150.00 F•S• <br /> Disposal Fee with Permit 300.00 280 11 ❑ .14500 ❑ ❑ .21 <br /> 550 U ❑ .24 <br /> Fiberglass Tank Disposal Fee Per Tank 400.00 _ 1000 12 n. ❑ ❑ .44 <br /> --- 1000-611. 0 0 .61 <br /> Fiberglass Tank Delivered 200.00 --- - 1500 ❑ ❑ .87 <br /> 2000 0 ❑ .37 <br /> Bobtail Disposal Fee 250.00 -- 2500 ❑ ❑ 1.14 <br /> 3000 ❑ ❑ 1.32 <br /> 4000 ❑ U 1.64 <br /> Qaffoauabo" !� 5000 ❑44- 2.42 Z. v/Z <br /> _ 6000 1.1 LI 2.84 <br /> R9 <br /> TOTAL CHARGES $ - __ ___ 7500 ❑ 0 3.26 <br /> 8000 U ❑ 3.44 <br /> All fees incurred are per load unless specified. __ 10000 ❑ 11 4.33 <br /> a El 3.82 <br /> Terms are net 30 days from date of invoice. _____ 12000 El [J 4.33 <br /> Contractor's signature represents acceptance <br /> of terms for payment,and confirms that tank NO. OF TANKS TOTAL NET TONS <br /> removal complies with Stale laws. / <br /> CONTRACTOR'S SIGNATURE -F— FIBERGLASS —STEEL 10 <br /> CERTIFICATE OF TANK DISPOSAL I DESTRUCTION <br /> THIS IS TO CERTIFY THE RECEIPT AND ACCEPTANCE OF THE TANK(S)AS SPECIFIED ABOVE.ALL MATERIALS SPECIFIED <br /> HAVE BEEN COMPLETELY DESTROYED FOR SCRAP PURPOSES ONN�yLY.�-/�J��p <br /> A! NO IX PVATE <br /> CONTRACTOR COPY <br />