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L. <br /> �-' DILLARD TRUCKING, INC. <br /> dba DILLARD ENVIRONMENTAL SERVICES 4079--z <br /> . <br /> P.O.BOX 579 <br /> BYRON,CALIFORNIA 94514 <br /> PHONE:(925j 634-6650 FAX:(925)634-0569 <br /> OATE PM JOB# CUSTOMER SITE ADDRESS CITY INT PM <br /> Woo <br /> DELIVERY PICKUP TIME UNIT# TYPE RT/OT LINER TARP <br /> Loot <br /> LIST ANY DAMAGE/MISSING PARTS,IN DETAIL <br /> UNIT# UNIT# <br /> �otl <br /> T P TOP <br /> FRONT FRONT <br /> Q LEFT SIDE Q Q LEFT SIDE Q <br /> TOP TOP <br /> FRONT <br /> = <br /> Q RIGHT SIDE Q Q RIGHT SIDE <br /> I <br /> I <br /> o <br /> FRONT EAR FRONT REAR ^ <br /> DRIVER SIGNATURE DATE �"" `� TRUCK <br /> By accepting delive f rented items, customer agrees to all terms and conditions of this rental contract. <br /> Customer acknowl dges receipt 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 F 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 />