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' 3392 <br /> L� Universal Environmentalripv. - 3 3 <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# _ �m Q DATE ? S� <br />' PO # <br /> CONTACT JOB # 73 `l 3 <br /> CUSTOMER G' O <br /> JOB LOCATION S Tcs c Il7`e. <br /> CITY STATE <br />' SERVICES PERFORMED he,4/1 U Ax`� <br /> DELIVER BIN# <br />' PICK UP BIN # <br /> PRODUCT��f -/ar _ ORIGIN 7-, c DESTINATION <br /> ARRIVE JOB ARRIVE DISPOSAL <br /> R <br /> DEPART JOB DEPART DISPOSAL o <br /> TRUCK# / TRAILER# "Z t� L START Q,240 STOP a?—On TIME HOUR <br /> CAPACITY TIME OUT //fid _ TO / 2mo9-C) LESS //Z HOUR <br /> # LOADS DM/YD/LBS/GALS LINER WIO NET HOUR <br /> DISPOSAL SITE 4P,,- PER DIEM TOLL <br /> RIVERS NAME < LABORER <br /> RIVERS SIG ATURE 'CUSTOMER AUTHORIZATION <br /> ' NOTE 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 1112%per month 18%per annum)on al!overdue accounts <br /> 1 � <br /> 1 <br /> 1 <br /> • <br />