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2600 North Central Expressway, Suite 200 800-669-5740 <br />Richardson, TX 75080 www.safety-kieen.com V�E CARE' <br />CUSTOMER NO. "'A "! ' <br />DUNS NO. 05�397 6551 FED ID NO, 396090019 <br />FOR SERVICE CALL BRANCH MANAGER DOC. EXP. <br />D095451011 <br />%IWO <br />I <br />- SCHEDLIUED Sc E1,1UL'E'D <br />ERVICE WEEK 11: R'. <br />18-44 <br />CREDIT PREVIOUS BALANCE <br />CODE <br />78359276 <br />BAL. OVER 60 DAYS <br />MACHINE PROPERLY GROUNDED <br />El F] <br />C <br />U <br />S <br />T <br />0 <br />M <br />E <br />0 <br />I <br />1,1 LY C2 I.- CS y <br />14253 S Airport Way <br />Manteca, CA 95336-8641 US <br />DBO1190 <br />Dba California Specialty Cheese <br />14253 S Airport Way <br />MAnteca CA US 95336-8641 <br />LOCAL PHONE NO STICKER <br />CUSTOME <br />SEGMENT <br />OUTER <br />CHAIN COUNTY <br />Svc. P/C <br />PROD <br />PC <br />Uj <br />STALLED <br />GENERATOR S <br />GENERATOR STATE ID NO. LAINIP ASSEMBLY <br />SPENT SOLVENT MEETS <br />LOCATION TAX EXEMPTION NO, <br />9�3L <br />CONDITION EMERGENCY CLOSING <br />SERVICE DATE ISALES REP NO. I <br />-IT-- <br />CUSTOMER P.O. NUMBER I CUSTOMER PHONE # I TAX CODE DATE EQPT/PROD ORDERED SERVICE TAX C.0 M.S TAX <br />PRODUCTTAX <br />OF LID UNOBSTRUCTED <br />� - I '� b S' -1 <br />1 0 19 <br />F� t, T.1 - 1) C, ��) I I <br />I <br />I <br />13 TOTAL <br />QUANTITY <br />14� UNIT <br />WTV0L <br />DEPT <br />SERVICE/ <br />PRODUCT <br />REMARKS/ <br />RKS' <br />UNIT PRICE UAN� <br />PRICE <br />SALES <br />CHARGE <br />TAX <br />TOTAL WASTE SOLVENTIDRUMS SERVICE CHANGE (Hm� <br />— cc 1 SERVICE TERM SQ DArt <br />CHARGE MIN. CLEAN 'P�Nlj '� I SK DOT TERM CODE: NO. <br />cow <br />CERTIFY THAT MY TOTAL <br />ASTE STHEAMS ARE WITHIN <br />ONE OF THL FOLLOWINC, <br />28TE! <br />OR "!.ONT. <br />SDS <br />GIVEN <br />1725371 <br />—177-27-e777-1 <br />J 1 <br />3 8 1 —.0 <br />84641 2 4 <br />El <br />2 <br />875465 <br />-72 -9 -4—f <br />700.6 1 <br />0 <br />700. ov, <br />F— <br />-SA-MPLE <br />F E. <br />E] - <br />0 <br />z <br />870540 1 -)5j- <br />_Bt)_ 0 <br />3B5. 0 <br />'38 . OT <br />385). 01 T <br />-7AFP= <br />F I <br />El <br />8 7 5 2 4 2, TT2'�i <br />21 257. 0 <br />... " 0 <br />= om <br />.:.25. 0 <br />�-;f IMP <br />LL F E. <br />El <br />5 <br />100030 <br />81.0". <br />81. 00 <br />81.00 <br />El <br />6 <br />a <br />0, 0 L> <br />U Z <br />L) <br />220 LOS TO 2.200 LEIS /MONTH <br />El <br />9 <br />El <br />10 <br />Cn <br />F-1 <br />il <br />LU <br />El <br />12 <br />GREATER AN 2 200 LBS,MONIH <br />-J 7 <br />1-1 <br />TOTAL-SERVICE/PRODUCTS 3�'d <br />I t " .- ' "T <br />USEPA TRANSPORTER 1 I�USEPA TRANSPORTER 2 ID NO. GENERATOR USEPA ID NE. <br />I (- "-� L ") 3 0 " <br />11 - US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.) <br />A. k k- 0 <br />oo(q�-')' <br />C. I -7A 0�') 66-1 �D`90U "A0 <br />D. <br />ESIGNATED FA, <br />CASH <br />C '. CK <br />HECK <br />CREDIT _ <br />TOTAL RECEIVED <br />INVOICE # AMOUNTS <br />APPLY PAYMENT TO- <br />E] TODArS SERVICEJSALE <br />[:] PREVIOUS BALANCE AS FOLLOWS <br />INVOICE * AMOUNTS <br />AMEX <br />Ll I I I I I I I I I I I I M VISA <br />IVIC <br />CUSTOMER REFERENCE <br />INFORMATION Ll I I I I El I I I I f FT7 <br />I MANIFEST CODE I SEQ # I <br />CHECK GOOD POOR YES <br />NO YES NO <br />TOTAL DUE <br />DECALS IN PLACE <br />APPROPRIATE MACHINE CONDITION AND LEGIBLE <br />I <br />MACHINE PROPERLY GROUNDED <br />El F] <br />00 NOT WRITE <br />Print Customer Name <br />wa <br />C"T <br />BOXES <br />LOCAL PHONE NO STICKER <br />z <br />Customers Authortzed Representative <br />& CLEANLINESS FUSIBLE LINK <br />AFFIKED TO MACHINE <br />Uj <br />STALLED <br />GENERATOR S <br />GENERATOR STATE ID NO. LAINIP ASSEMBLY <br />SPENT SOLVENT MEETS <br />2 <br />CONDITION EMERGENCY CLOSING <br />ACCEPTANCE CRITERIA 11 El <br />OF LID UNOBSTRUCTED <br />0 <br />12 CONJAINERS <br />No <br />TYPE <br />13 TOTAL <br />QUANTITY <br />14� UNIT <br />WTV0L <br />SK DOT NUMBER <br />CERTIFY THAT MY TOTAL <br />ASTE STHEAMS ARE WITHIN <br />ONE OF THL FOLLOWINC, <br />28TE! <br />OR "!.ONT. <br />0 <br />Lij <br />-J <br />To .1Z <br />0 <br />z <br />INITIALS <br />y <br />L) <br />220 LOS TO 2.200 LEIS /MONTH <br />Cn <br />LU <br />GREATER AN 2 200 LBS,MONIH <br />-J 7 <br />U) 7 <br />INITIALS <br />I CERTIFY T AT NO MATERIAL CHANGE HAS 'CURRED US <br />H or A EPA ID NO. <br />z — <br />E ITHER IN THE CHARACTERISTICS .1 THE WASTE <br />< 1' <br />MATERLALS OR IN THE PROCESS GENERATING THE <br />STATE ID NO. <br />: <br />Uj <br />MANIFEST NO. <br />WASTE MATERIALS <br />I AGREE TO PAY THE <br />T OTAL CHARG <br />No <br />M No <br />ABOVE CHARGES AND TO BE BOUND BY THETER S A <br />T <br />ONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT <br />(FROM ABOV <br />> <br />PLEASE CHARGE M Y ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE <br />T <br />ii - <br />ILDR-MESSAGE <br />INDICATED IN THE PAYMENT RECEIVED SECTION THE INDIVIDUAL SIGNING THIS <br />I ...I.T Is OMY AUTHORIZED TO SIGN AND SIND CUSTOMER TO ITS TERMS <br />WASTE MIN <br />(FROMABOV <br />LU <br />C/) <br />I MANIFEST CODE I SEQ # I <br />I so� � �'o <br />UE AREA BELOW <br />TOTAL DUE <br />00 NOT WRITE <br />Print Customer Name <br />Ely: <br />Customers Authortzed Representative <br />THIS AGREEMENT CONTINUES ON THE REVERSE SIDE <br />I so� � �'o <br />UE AREA BELOW <br />