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LT Universal Environmenbl, Inc. 32600 <br /> 4101 Industrial Way P O Box 996 <br /> Benicia, CA 94590 707-747-6699 <br /> HAZARDOUS WASTE HAULING REMEDIATION INDUSTRIAL CLEANING <br /> DISC 3240 ICC#MC271664 <br /> MANIFEST# e DATE <br /> PO # <br /> CONTACT JOB# <br /> CUSTOMER Q G. SG d <br /> JOB LOCATION ,�k ,,, a �,,• C'C <br /> CITY STATSL- <br /> SERVICES PERFORMED �, � � � � �� <br /> Ad ze <br /> DELIVER BIN# <br /> PICK UP BIN# . <br /> PRODUCT ORIGIN DESTINATION <br /> ARRIVE JOB v/ I ARRIVE DISPOSAL nl �DEPART JOB 8^ A.�r DEPART DISPOSAL I <br /> TRUCK# /,Z TRAILER # 1 START STOP TIME <br /> CAPACITY TIME OUT TO LESS �1 <br /> # LOADSDM/YD/LBS/GALS LINER W/O NET <br /> DISPOSAL SITE c PER DIEM TOLL G <br /> DRIVERS NAME / LABORER <br /> DRIVERS SIGNATURE CUSTOMER AUTHORIZATION <br /> NOTF In the event of action or proceeding upon this agreement the court shall award to the prevailing <br /> + p g party court (� <br /> L Interest will be charged at the rate of I i12%per month 18%jLer annum)on all overdue accounts a <br />