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LrE Universal Environmental, Inc. �a <br /> 4101 Industrial Way P O Box 996 Benicia, CA 94510 707-747-6699 <br /> HAZARDOUS WASTE HAULING REMEDIATION INDUSTRIAL CLEANING <br /> DISC 3240 ICC#MC271664 <br /> MANIFEST# DATE 7 -/ Zp <br /> - <br /> PO # <br /> CONTACT JOB# ,Y'y?7 <br /> CUSTOMER - <br /> JOB LOCATION <br /> CITY Srae,,r-" STATE C/4 <br /> SERVICES PERFORMED <br /> DELIVER BIN # <br /> PICK UP BIN# <br /> PRODUCT ORIGIN DESTINATION <br /> ARRIVE JOB leoo ARRIVE DISPOSAL <br /> DEPART JOB 0 0 DEPART DISPOSAL <br /> TRUCK# _/ _ TRAILER# z 20 , START�_ STOP oo yj' TIME HOUR <br /> CAPACITY TIME OUT TO L HOUR <br /> # LOADS ( DMIYD/LBS/GALS LINER WIO NE HOUR <br /> DISPOSAL SITE X1/� PER DIEM TOL <br /> DRIVERS NAME LABORER <br /> DRIVERS SIGNATURE CUSTOMER AUTHORIZATION <br /> NOT In the event of action or proceeding upon this agreement the court shall award to the prevailing party court costs and resonable attorney fees <br /> Interest will be charged at the rate of l 112%per month(18%per annum)on all overdue accounts <br />