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*I uIVUnNaN wr-rste k�Uy11 1, �����-• <br />CENTRAL ENVIRONP&NTAL INC. <br />EMERGENCY RESPONSE SERVICE AUTHORIZATION <br />The undersigned customer hereby aulhoti= and requests Central Environmental, Inc. (CEI) to perform the work <br />., <br />0= 1W As contidicmdon for the performance of such work the customer agrees to pay' CEI all amounts <br /><ivltttlh' 15 days of rerelpl of itivoices for all services required to perform such work, including but not limited to the <br />:9110111)(5 speeitled thcreutfor Labor, Paris, Materials and Equipment, Tbc customer and CEI agree that the terms and <br />'Conditions set forth below will gov this agreement. <br />T., dz/a�q16 -- /-; ;/cam <br />This is a dontract for servim and is NOT an admission of Civil or Criminal L.labiGly to soy Mid party. <br />SERVICE AUTHORIZATION <br />COMPANYNAh, / ! F/tvVd� 3 ?_____-._� <br />ADDRESS d Lf" <br />�Z <br />CITY L TATE ZIP CODE 1 <br />TYLEPHO E EXT: <br />ignature Date Print Name Title <br />IbB LOCATION: <br />DESCRIPTION OF SERVICES: G <br />OWNER OF MATERIAL <br />' wiAbDRESS: CfIY: STATE: <br />• );'FEI:EPiiONE: ( 1 FAX: f ,Z <br /><'INSURANCE CARRIER: TELEPHONE: ) <br />•�.r' ,-',*:SIGNNG TIM WORK AUTHORIZATION, THE CUSTOMER AND M AGREETO THE FOLLOWING TERMS AND <br />I GONDMONS. <br />g�. <br />NET IS DAYS AFTER ISSUE OFINVOICE <br />e �y (Z).::IN'fERPS 1'; Cuslotncr ttg[tts to pay CEI interest an past due ba{ace at lite maxim=lawfnt rate. <br />(3)r1NSLIRANCE' 4lrstorher. agrees to pay CEI citargcs in acGOrdaFtce wi h the temra a d conditions of this <br />tiiliorization. Reimbutsrment or recoser fmm an iastucr s (be Customer% responsibility. <br />..(4). ATTORNEY'S FEES: Should eithet party bring suit In Court to cnfoee0 the provisions hereof, including <br />• .'CoUeclian of unpaid charges, any judgment awarded shall include court cost and reasonable atkwneyt fees to the <br />sucdesvful party. <br />CEI REPRESfiNT.47iV <br />Signalu <br />