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°`~' ~ ate.-.._ i ~4 p~, ` Y <br />~~ ~~° ~~° ~~~ .•'INVOICE~_ .~ ~~+~~~~.;RTHEBMORU1081NC ~.- !=j <br />'Thermo• Fluids. inc. ~ ~'~sr°"'ER P~ ~ ~ - PN~ ~K <br />`-. PO ;60X31001-0723 <br />The k Shinn ACIaIQWLED~EMENT/REf.OP~ ~ . - -PASADENA; CALIFORNIA 91110-(I7; <br />~Fed.1.0.~59-9210374 ~ TERMSiNET10DAYS - <br />r~~ <br />CUSTf > '' ~-?; ~ ~ ~ • -, ., MANl~EST# !~/~~ ' ~crg .3~ ~.:. ;,EPA# to aopikaete) .. - <br />GENERATORA:USTOMER NAME t/ r,2 / C a ~ ~ P.0 # ~ _ <br />t7.-, <br />ADDRESS 7ELEPHONE# <br />CITY ,~.+''-x •,.^ •~. A STATE <br />BILLIND ADDRESS (IF DIFFERENT) <br />~'" ZIP <' t nS < METHOD OF PAYMENT <br />MATERIALS (~~~~~ <br />TANK SIZE QUANTRr <br />P/U DEL UNIT ~ TOTAL <br /> <br />USED DIL <br />~'~/%..,~ <br />,-1? /C1 <br />. -. •.i r,~p~{ <br />f <br />OFF SPECIflCAiION USED DIL <br />GAS! DIESEL (CIMa one) <br />UNUSED FUEL <br />~' -- ---' - <br />OIL WATER MUIiUAE ' <br />FIEID SCREEN HALOG91 TEST ) ~! ,~ .' Ti!i! i ,.~f r`;' ;`~ <br />NON RCRA WASTE AN7IFREEZE `(See Belor) <br />ANTIFREEZE PREAUX (Circle aae) <br />CONCENIAAIEDAIEX000L <br />~ <br />~', ,.,.~,,:. ;~.. =<.~ ~~:.,- <br /> <br />SPECUILTY FlLTERS <br />SPIN ONS <br />SLUDGE/ABSORB/DIRT (Circle aae) <br />OIL WATER SEPARATOR! <br />SUMP (Cirefe one) , <br />- <br />:ATCH BASIN <br />tERVICE FEE <br />iTHER <br />THER <br />QtT wcltNP DATE TOTALS ~j <br />CUSTOMER'S NAME PRINTED <br />IPPING NAME: RO, ENVIRONMENTALLY HAZARDOUS SUBSTANCES, LIQUID, N.O.S. (Ethylene Grycol), 9,UN30B2, PGlll <br />chicle meets RO 5000 LBS or greater /ar Ethylene Grycaq !. <br />"- <br />OGENTESTm:,a'~•%)D ~YES~ NO HALOGEN TEST RESULTS6h r,;-' PPM ~_ <br />iwtork deserlp0oo of anode and marce: (aback aoalFlleal dad, MSOS, etc. to hack) <br />ed Belavr, suh{ect to lemu aed cae <br />IORIZED CUSTOMER'S SIGNATURE <br />ER'S SIGNATURE <br />MNG FACILITY 816NAIURE <br />d as reverse side at terms farm. <br />TRUCN# <br />,.i <br />DAIS ~ I %% l U'<_~, <br />FACILITY NAME PRIMED <br />IVING FACILITY CODE f.~ r~ (SEE REVERSE) <br />ID OF MEASURE ORM (DRUMSI. GAL IsAI r nusr ' °°'^^""^"' "- <br />