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I . <br /> :-- ENVIROPUR WEST CORPORATION <br /> i 13331 N. Hwy 33 / P.O. Box 1167 STATE MANIFEST# <br /> USED OIL HAULER# 86-050 <br /> Patterson, CA 95363 EPA# CAD083166728 <br /> (209) 892-6742 / (800) 874-4444 HAZARDOUS WASTE <br /> HAULER REG# 2591 <br /> ( -tel INV.# 75839 <br /> INTERVAL DATE <br /> C NAME t ^-� D ER TRUCK <br /> ! ! <br /> U &0 T <br /> ADDRESS - BILLING ADDRESS IF DIFFERENT E CASH <br /> M Cn-y TATE ZIP PHONE CITY STATE ZIP NET 10 DAY' <br /> � r S <br /> PO 7t <br /> • PLEASE PAY FROM THIS INVOICE • <br /> PRODUCT GALLONS HOURS RATE AMOUNT <br /> HAZARDOUS WASTE OIL 441 <br /> � v`, <br /> 6 <br /> i <br /> TEST FEE <br /> HAZARDOUS WASTE <br /> HOURLY CHARGES <br /> I <br /> certffyAmount to shovrn __ be correct. _ <br /> 4 / `�rG✓, <br /> (f (Customer Signature) (Driver Si ature) <br /> PAYMENT DUE UPON RECEIPT OF INVOICE.A service charge of 1!/2%per month shall be charged <br /> on all past due accounts. In the event this account becomes delinquent and it is necessary to institute TOTAL CHARGES V� <br /> legal proceedings,purchaser agrees to pay reasonable attomey's fee and court costs. <br /> RSINVMMP91 WHITE:Customer CANARY:Alphabetical PINK:Numenc GOLDENROD:Rle <br />