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08/29/2003 FRI 05:48 FAX 661 393 3834 MP ENVIRONMENTAL-BAK 003/006 <br /> —— ——— ———————— ————————— ——————————— <br /> 10986 <br /> GOLDEN STATE METALS, INC, TANK DISPOSAL FORM <br /> P.0, Box 70158 - 2000 E.Brundage Lane <br /> Bakersfield,California 93387 Date <br /> PhCne(805)327-$5$9 - Fax(oo5)327-5749 <br /> VV CJ <br /> Scrap Metals, Processing a Recycling Contractor's <br /> Llconso No. <br /> Contractor's <br /> NNI I ROW M_Z)�L Phone No. <br /> CONTRACTOR: 'U <br /> ADDRESS: Hc_Vo\ _m* /<,�1wile 3_11 <br /> JOB SITE: <br /> 2_2�6 2- <br /> ADDRESS: 2300 <br /> DESTINATION: G.S.M. - 2000 E. BRUNDAGE LANE BAKERSFIELD,CA 93387 <br /> HAULEFI: . U-WMI L—mj LICENSE NO: <br /> WEIGHT CERT.NO: <br /> EHSD PERMIT NO: OTY GALLONS SERIAL NO. NET TONS TOTAL <br /> 250 <br /> COUNTY: <br /> 550 .24 <br /> :DX. <br /> 1000 6 tj .51 <br /> INSPECTION <br /> —7CLEANS&DIRTYI(I 2DOO .97 <br /> 7 R A: <br /> CLEAN&DRY(ACCEPT),0 <br /> rl RESIDUALS PRESENT(REJECT) <br /> M;, <br /> "Hi <br /> LEL FIFADiNG 5000 2.42 <br /> .......... <br /> OXYGEN CONTENT <br /> 7500 <br /> DISPOSAL FEE R <br /> 9000 3.82 <br /> SCRAP VALUE 't 11"i <br /> A, <br /> 12000 p 4.93 <br /> OTHER <br /> TOTAL <br /> 2 lil <br /> All fees Incurred are per load unless spocifled. Terms are <br /> not 30 days from receipt of tank. Contractor's$Ignature <br /> reprosontsatceptance of terms for payment,and confirms <br /> -,-WIN�" <br /> that tank removal complies with State laws. <br /> ............... T8 <br /> 1p, <br /> tl <br /> CONTRACTOR'S SIGNATURE <br /> ka <br /> CERTIFICATE OF TANK DISPOSAL I DESTRUCTION <br /> 791Afs TO CERT11 THE R EIP AND ACCEPTANCE OF THE TANK(S)AS SPECIFIED ABOVE, ALL MATERIAL BE COMPLETELY <br /> DES I ;JEGIRI�D WILL <br /> YED F SCRAP C LING URPO S ONLY. <br /> Au RIZE <br /> = - T. <br /> wmrrF—contractor copy - YELLOW—FlIeCapy - PINK—Parmonant copy <br />