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Lff Universal Environmentai, Inc. 28007 <br /> 4101 Industrial Way P O Box 996 Benicia, CA 94610 707-747-6699 <br /> HAZARDOUS WASTE HAULING REMEDIATION INDUSTRIAL CLEANING <br /> ' DISC 3240 ICC#MC271664 <br /> MANIFEST# 39� _ DATE 3' <br /> PO # <br /> CONTACT JOB# <br /> Jet- <br /> CUSTOMER <br /> � o <br /> ' JOB LOCATION <br /> CITY ,�„a STATE Cc., <br /> SERVICES PERFORMED <br /> DELIVER BIN# <br /> PICK UP BIN# <br /> c1 PRODUCTc7iZ {,tc ORIGIN �� <br /> Sr_c�c,¢ 1 DESTINATION j7��,oa�,,,.�-r-t,� <br /> ARRIVE JOS 71ARRIVE DISPOSAL flot <br /> DEPART JOB a 11'` DEPART DISPOSAL y <br /> TRUCK# 1l TRAILER# ,cam START STOP <br /> TIME HOUR <br /> CAPACITY TIME OUT /i TO /Fav LESS HOUR <br /> # LOADS IND/LBSeit Lq LINERW/O NET HOUR <br /> DISPOSAL SITE§1E ogtj,pw",q Ct iT PER DIEM TOLL <br /> DRIVERS NAME ,�,) � c.tc,30a LABORER <br /> DRIVERS SIGNATURE 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 1 1/2%e2r month(18%per annum on all overdue accounts <br />