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nF .7n)r1Q <br /> C. <br /> PRC PRC PATTERS `�7 y <br /> ON, INC. <br /> DBA Refineries Service -,C <br /> °�,��•��°o�J 13331 N. Hwy 33/P.O.BOx 1167 <br /> STATE MANIFEST#�.7�r�1%Z <br /> X269) 92-6742/C 00) 874-4444 63 USED OIL HAULER#= <br /> EPA# CAD083166728 <br /> HAZARDOUS WASTE <br /> HAULER REG#-91 <br /> NAME DATE <br /> INV # 20076 <br /> S Cr� <br /> T ADDRESS D VE <br /> Q / TRUCK# I <br /> /r BILLING ADDRESS IF DIFFERENT <br /> M —ln, Y,,� T <br /> E CITY STATE zip E CASH <br /> R `Y7�4 PHONE <br /> CITY STATE ZIP R <br /> 1 M ` <br /> NET IO DA <br /> S 3o <br /> PO# <br /> • PLEASE PAY FROM THIS INVOICE • <br /> PRODUCT <br /> AZARDOUS WASTE OIL GALLONS HOURS <br /> RATE AMOUNT <br />.ST FEE Q <br /> kZARDOUS WASTE <br />)URLY CHARGES <br /> rtifY .ount shown above to tie corre t. <br /> G � 6 c <br /> (Customer Signature) <br /> PENT DUE UPON RECEIPT OF INVOICE.A service charge of 1 z%per month shall beth(Driver ignature) <br /> past due accounts. In the event this account becomes delinquent and it is necessary to institute TOTAL <br /> xoceedings,purchaser agrees to pay reasonable attorney's fee and court costs, charged <br /> CHARGES <br /> MP91 l/ <br /> WHITE:Customer � <br /> CANARY Alphabetical PINK:Numeric GOLDENROD:File <br /> 0 <br /> J <br />