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11/13_/2008 14: 49 2093312012 SJC PARKS PAGE 06114 <br /> r' rr wWr tuuV 11a 11 .G C1:I�.QO:JQlL G1 1AN HAk'J-UIRS DACE: 03/0: . <br /> lid <br /> IN an no <br /> .L Hal go <br /> ea- <br /> EfIVINO TA114 5ER*Er <br /> �N�CC►tC / UThIfJ Tia Chi Drr LUN <br /> Dater `�j4 <br /> To' Clean harbors Envi%n(nentaE Service dry <br /> Fax: SA000M <br /> Phone:793.792.5249 <br /> From: Name: ArOunt Nurnberg <br /> Com„IDan 'SAn Jamin rem'Irk�F�eg „ Telephone, 209.331-2W <br /> MaiftnAddress: 41793 N.Mike Grove Rd. Fax: ; i <br /> C /Mate: Lodi *S---..-_ �;,�l,f �.._.•.,.,� _ <br /> Zip Code: 95240 <br /> This in authaftwelon to PRY the Ioliowing Duan 14arbora Invokes: <br /> invoice Number Daze Amont Involon Number Bate <br /> ]}7� Antaurrt <br /> 109<fJ8 93.. <br /> Tobd Charges to be APPOOd to credit card will be for the foiiowring amount <br /> VESA MASTERCARD AWRICAN EXPRESS INVOICE CHECK <br /> PIN# CHECK* <br /> N . "res <br /> If yes,what is ft arnount'� <br /> Name as it appears on Card: Hugh Mullen <br /> company Mame: <br /> Carr!Billing Address <br /> C)r) �► C! <br /> Credit Card Number; 4 a 157 it <br /> Card Autho' Date: <br /> Authortm&n Signature: zi <br /> RETURN RECEIPT 6Y: FAX U.S.MAIL <br />