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CSG SK -SSL -BOX -23 Raymond Gomez 06/08/18 13:20 PAGE 1 <br />Safety-Kleen Systems, Inc. <br />2600 N Central Expy, Suite 200 <br />Richardson, TX 75080 <br />CORPORATE: 800-669-5740 <br />24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br />2095451011 <br />UNPAID BALANCE THIS RECEIPT 861.33 <br />GENERATOR STATUS <br />0-220 lbs/month <br />Customer certifies that (i) the above-named materials are properly <br />classified, packaged, marked and labeled, and are in proper condition <br />for transportation according to the applicable regulations of the <br />Department of Transportation (ii) no material change has occurred <br />either in the characteristics of the waste/material or in the process <br />generating the waste/material, and (iii) the above referenced <br />Generator Status is correct. Customer agrees to pay the above charges <br />and to be bound by the terms and conditions (1) set forth in (a) the <br />General Terms and Conditions provided separately to Customer or (b) <br />any SK agreement signed by Customer and SK, and (2) incorporated <br />herein by reference. Unless otherwise indicated in the payment <br />received section, SK is authorized to charge Customer's account for <br />this transaction. If Customer fails to make payment when due, an <br />amount equal to the lesser of (i) 1.58 per month (18% per annum) or <br />(ii) the maximum amount allowed by law, will be added to all unpaid <br />amounts outstanding. Customer certifies that the individual signing <br />this Service Acknowledgement is duly authorized to sign and bind <br />Customer. Customer acknowledges that it is responsible for maintaining <br />M I <br />a J <br />R E C" El E 10-0-0% <br />AUG 09 2018 <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />REFERENCE NBR. <br />CUSTOMER# ST42948 Stockton Delta Resort, LLC <br />76970771-1802637956 <br />14900 W Highway 12 <br />SRVC WEEK: 2018-22 <br />Lodi CA 95242-0000 <br />SRVC DATE: 06/08/18 <br />PHONE 209-283-1589 <br />BILL TO CUSTOMER# BILL TO ADDRESS: <br />SA32681 County of San Joaquin DPW/Solid Waste <br />1810 E Hazelton Ave <br />Stockton CA 95205-6232 <br />PHONE 909-947-9363 <br />PURCHASE ORDER# <br />TAX EXEMPT# <br />PRODUCT/SERVICES <br />SERVICE/ <br />TOTAL <br />PRODUCT QTY UNIT PRICE <br />TAX CHARGE <br />1647100/ <br />875460 CNO-NON HAZARDOUS SOLID 5 2.000 249.9600 <br />0.00 499.92 <br /># CONTS: 2 TSDF: SJ MANIFEST#: 006580885sks FORM CD: US <br />SHIP# 225560914 <br />CNT#: 180524603597 QTY: 150 WT/VOL P PROF# 1647100 <br />SKDOT 8297321 <br />CNT#: 180524603595 QTY: 150 WT/VOL P PROF# 1647100 <br />SKDOT 8297321 <br />83383 DRUM,55 WASTE O.F. 2.000 55.0000 <br />0.00 110.00 <br />3383 DRUM,55 GAL FOR O.F. 3.000 10.0000 <br />0.00 30.00 <br />8003369 DRUM, 55 GL BLACK STEEL 0 3.000 10.0000 <br />2.33 32.33 <br />7207 MAT, SINGLE WGT OIL 16" X 2.000 81.0000 <br />12.56 174.56 <br />SERVICE TERM 24 WEEK <br />100001 FEE, FUEL SURCHARGE 1.000 13.4800 <br />1.04 14.52 <br />3230 TAX HANDLING NIC DRUM DROP 30 3.000 0.0000 <br />0.00 0.00 <br />----------------------------------------- <br />TOTAL SERVICE/PRODUCTS 419.4400 <br />15.93 861.33 <br />TOTAL CHARGE 861.33 <br />CREDITS <br />0.00 <br />TOTAL DUE <br />--------------- <br />861.33 <br />UNPAID BALANCE THIS RECEIPT 861.33 <br />GENERATOR STATUS <br />0-220 lbs/month <br />Customer certifies that (i) the above-named materials are properly <br />classified, packaged, marked and labeled, and are in proper condition <br />for transportation according to the applicable regulations of the <br />Department of Transportation (ii) no material change has occurred <br />either in the characteristics of the waste/material or in the process <br />generating the waste/material, and (iii) the above referenced <br />Generator Status is correct. Customer agrees to pay the above charges <br />and to be bound by the terms and conditions (1) set forth in (a) the <br />General Terms and Conditions provided separately to Customer or (b) <br />any SK agreement signed by Customer and SK, and (2) incorporated <br />herein by reference. Unless otherwise indicated in the payment <br />received section, SK is authorized to charge Customer's account for <br />this transaction. If Customer fails to make payment when due, an <br />amount equal to the lesser of (i) 1.58 per month (18% per annum) or <br />(ii) the maximum amount allowed by law, will be added to all unpaid <br />amounts outstanding. Customer certifies that the individual signing <br />this Service Acknowledgement is duly authorized to sign and bind <br />Customer. Customer acknowledges that it is responsible for maintaining <br />M I <br />a J <br />R E C" El E 10-0-0% <br />AUG 09 2018 <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />