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Lf' Universal Environmental, Inc. 28840 <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# O ,!�Z 7L DATE <br /> PO # <br /> CONTACT JOB# Z <br /> CUSTOMER T�O <br /> JOB LOCATION <br /> CITY ?)C k- To AJ STATE CA <br />' SERVICES PERFORMED i7 / C/ <br /> DELIVER BIN# <br />' PICK UP BIN# <br /> PRODUCT ORIGIN cS7zc-x--rzrxj DESTINATION <br /> ARRIVE JOB ARRIVE DISPOSAL Q 7 <br /> DEPART JOB DEPART DISPOSAL g <br /> TRUCK# 11b7 TRAILER# 2Zoz. START r)-4t STOP TIME HOUR <br /> CAPACITY TIME OUT TO LESS HOUR <br /> #LOADS DMIYDILBS/GALS LINER W/O NET HOUR <br /> DISPOSAL SITE PER DIEM TOLL <br /> RIVERS NAME )��/.s�' / �� - _ 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 1 112%per month I8%per annum on all overdue accounts <br />