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� }J�1V1A\ F1�TAMC O 520 <br />2® <br />METALc� <br />RECYCLING .INC. TANK DI POSAL FORM <br />2202 S. MILLIKEN AVE. • ONTARIO, CA 91761 Date: <br />(909) 988-8000 i <br />• Job# <br />P.O.# <br />I <br />CONTRACTOR: <br />ADDRESS: <br />JOB SITE: <br />ADDRESS: <br />DESTINATION: A.M.R. 2202 S. MILLIKEN AVE., ONTARIO, CA 91761 <br />DATE <br />TIME <br />PROJECTED TANKS <br />ORDERED Sr. <br />UC. NO. <br />TIME IN: <br />SPECIAL INSTRUCTIONS: <br />TIME OUT: <br />3 <br />✓ Services Rendered Cost <br />TANKS RECEI D <br />_ Disposal Fee <br />OTy GALLONS F S* NET TONS <br />TOTAL <br />_ Extensive Loading Time <br />280 O O .14 <br />500: ❑ ❑ s1 <br />_ Disposal Fee with Permit <br />550 ❑ 13 .24 <br />1000 - u n. ❑ ®= .aa <br />Fiberglass Tank Disposal Fee Per Tank <br />1000 - 6 e. ®p .61 <br />1' <br />Fiberglass Delivered <br />i000 O 0 .97 <br />Bobtail Disposal <br />3000O ❑` ' 1.32 <br />a El fly- <br />Cancellation Fee <br />swo 2-42 <br />TOTAL CHARGES <br />7500 ❑ ❑ 3.28 <br />AN tees incurrW are per bad unless specified. Terms are net 30 <br />s0� ❑ (3 se2 <br />days tram data of invoice. Contractor's signature represents <br />'1 x._' 4 O „ ,� . ; <br />a of terms for payment, and confirms that tank removal <br />12M 4.93, <br />❑ <br />NO. OF TANKS TOTAL NET TONS <br />`Slate <br />gF - FIBERGLASS. - STEEL 105 <br />CONTRACTOR'S SIGNATURE <br />