Laserfiche WebLink
JUL 0 9 2018 <br /> CSG SK-SSL-BOX-21 Brandon S Gaither 03/13/18 12:13 PAGE 1 ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Espy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-K1een) <br /> 2095451011 <br /> REFERENCE NSR. <br /> CUSTOMER# KI18372 Kia Country 76165139-1800872934 <br /> 1515 N Main St SRVC WEEK: 2018-11 <br /> Manteca CA 95336-3243 SRVC DATE: 03/13/18 <br /> PHONE 999-999-9999 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> KI18372 Kia Country <br /> 1515 N Main St <br /> Manteca CA 95336-3243 <br /> PHONE 999-999-9999 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 3383 DRUM,55 GAL FOR O.F. 3.000 5.0000 0.00 15.00 <br /> SERVICE TERM 12 WEEK <br /> 898560 CARTRIDGE OIL FILTERS 55G 1.000 90.0000 0.00 90.00 <br /> SERVICE TERM 12 WEEK <br /> # CONTS: 1 TSDF: WI MANIFEST#: 006462054SKS FORM CD: US SHIP# 224968458 <br /> CNT#: 180306038648 QTY: 140 WT/VOL P PROF# 156777 SHOOT 7612003 <br /> 83383 DRUM,55 WASTE O.F. 2.000 25.0000 0.00 50.00 <br /> SERVICE TERM 12 WEEK <br /> 90837 MODEL 90 W/2381 & 6365 1.000 109.0000 8.99 117.99 <br /> SIN 13130188 TAG 00001170SX13130188 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 0.0000 0.00 0.00 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 3.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 229.0000 8.99 272.99 <br /> TOTAL CHARGE 272.99 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 272.99 <br /> UNPAID BALANCE THIS RECEIPT 272.99 <br /> Machine clean and good condition? Yes <br /> Lamp Assembly Condition Yes <br /> Decals in place and legible? Yes <br /> Fusible link installed? Yes <br /> Emergency closing of lid unobstructed? Yes <br /> Machine properly grounded? Yes <br /> Local Phone No. Sticker Affixed to Machine Yes <br /> Spent solvent meets acceptance criteria? Yes <br /> GENERATOR STATUS <br /> 220-2200 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 theapplicable 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 />