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f <br /> m t " s <br /> 0� <br /> DILLARD TRUCKING, INC. <br /> o,' <br /> a b <br /> dba DtLL.ARD <br /> 'ENVIRONMENTAL SERVICES , <br /> Po.ebx sus 6470 <br /> '4vic� <br /> BYRON,CALIFORNIA 94514 w <br /> ! , <br /> M <br /> PHOt%E ($25)634-68So FAX (825)634-0,S69 <br /> f , <br /> DATE <br /> EIJ L PM CUSTOMER, SITE AD RESS <br /> " <br /> CITY INT PM <br /> 0 <br /> yyy <br /> DELIVERY PICKUP TIME UNIT#- TYPF RT'r'O'T ' ' ,' ;LINER TARP <br /> m <br /> f Ik <br /> LIST ANY DAMAGE f MISSING PARTS,IN DETAIL <br /> IT# .:: <br /> ra <br /> � - <br /> t <br /> ,TCP s <br /> ..r <br /> TOP <br /> y <br /> xa <br /> A € <br /> t=R© T FRONT r. . . <br /> LEFT SIDE <br /> &. LEFT SIDE . C <br /> TOP ... <br /> TOP <br /> w <br /> " ti <br /> RONT �� <br /> FF <br /> R1.GHT SIDE a s RIGHT SIDE <br /> a -- <br /> :. � <br /> F, <br /> ................ <br /> t <br /> =T, S <br /> FRONT REAM <br /> FRONT REAR " <br /> DRIVER SIGNATURE <br /> DATE 3� :�� �3 =- ..TRUCK# 10 � <br /> By accepting delivery of rented items,customer agrees'to all terms and conditions of this rentat contract. I <br /> Customer acicrsow'ledges receipt of rented items in good order with exceptions noted above <br /> CUSTOMER SIGN ATURI r) <br /> DATE, TRUCK# � <br /> • :' _... <br /> 'No one at jobsite to receEve units; driver signs for Customer. , <br /> W. <br /> 1 <br /> THIS IS NOT AN INVOICE <br /> ESTIMATED COST FOR REPAIRS: Ma#led invtjice to follow <br /> REPLACEMENT TARP TOP � OUTSIDE REPAIRS <br /> REPLACEMENT PARTS x. 9 <br /> ?WHEEL(S) L- ...__ HiNC ES =.1: R'AIL'S f <br /> `i BODY I <br /> DOOR 'LOOKS <br /> PAINT <br /> —� <br /> Terms and Conditions,-..Bills are due and payable within 30 days ofinvoice date.We reserve the right to assess 1.5v,o i <br /> finance charge per month on past due accounts.Customer.assumesfull responsibility for all rented Items,including sale <br /> .and proper use.-Ciperation, routine-maintenance, and storage. Customer is responsible for all loss, damage or repair at <br /> cast plus <br /> CLIENT COPY <br />