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DILLARD TRUCKING, INC. <br /> dba DILLARD ENVIRONMENTAL SERVICES 4079-- <br /> P 0.BOX 579 <br /> BYRON,CALIFORNIA 94514 y� <br /> PHONE:(925)634-6850 FAX:(925)634-0569 <br /> DATE PM JOB# CUSTOMER SITE ADDRESS CITY INT PM <br /> --U ---�2G cif' . So/ w LINA' 00 <br /> DELIVERY PICKUP -TIME UNIT# TYPE RT/OT LINER TARP <br /> dd <br /> LIST ANY DAMAGE/MISSING PARTS,IN DETAIL € <br /> c r3 ✓Y� <br /> UNIT# 86 10oil UNIT# <br /> T P TOP <br /> FRONT FRONT <br /> Q LEFT SIDE Q Q LEFT SIDE Q <br /> TOP TOP <br /> FRONT <br /> Q RIGHT SIDE Q Q RIGHT SIDE Q ' <br /> i <br /> FRONT EAR FRONT REAR <br /> DRIVER SIGNATURE f� DATE TRUCK <br /> By accepting delivKdesreceipt <br /> rented items, customer agrees to all terms and conditions of this rental contract. <br /> Customer acknow of rented items in good order with exceptions noted above. <br /> CUSTOMER SIGNATURE(*) DATE TRUCK# <br /> "No one at jobsite to receive units, driver signs for customer. <br /> THIS IS NOT AN INVOICE <br /> ESTIMATED COST FOR REPAIRS: Mailed invoice to follow <br /> REPLACEMENTTARP TOP OUTSIDE REPAIRS <br /> REPLACEMENT PARTS <br /> WHEEL(S) HINGES, RAILS BODY <br /> DOOR LOCKS TOP PAINT <br /> Terms and Conditions: Bills are due and payable within 30 days of invoice date.We reserve the right to assess 1.5% <br /> finance charge per month on past due accounts.Customer assumes full responsibility for all rented items, including sale <br /> and proper use, operation, routine maintenance, and storage.Customer is responsible for all loss,damage or repair. <br /> WHITE - CLIENT YELLOW-JOB FILE GREEN-ACCOUNTING GOLDENROD- DISPATCH <br />