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CSG SK-SSL-BOX-21 Brandon J Gaither 11/07/16 13:12 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMER# GA15065 Gardner Trucking/Classic Sales In 71996461 <br /> 2577 W Yosemite Ave SRVC WEEK: 2016-46 <br /> Manteca CA 95337-9641 SRVC DATE: 11/07/16 13:11 <br /> PHONE 785-690-0109 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> GA15065 Gardner Trucking/Classic Sales In <br /> 2577 W Yosemite Ave <br /> Manteca CA 95337-9641 <br /> PHONE 785-690-0109 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 83383 DRUM,55 WASTE O.F. 2.000 108.1600 0.00 216.32 <br /> SERVICE TERM 2 WEEK <br /> 3383 DRUM,55 GAL FOR O.F. 4.000 20.6000 0.00 82.40 <br /> SERVICE TERM 2 WEEK <br /> 898560 CARTRIDGE OIL FILTERS 55G 2.000 250.0000 0.00 500.00 <br /> SERVICE TERM 8 WEEK <br /> # CONTS: 2 TSDF: WI MANIFEST#: 005728169SKS FORM CD: US SHIP# 220791852 <br /> CNT#: 161102174207 QTY: 150 WT/VOL P PROF# 156777 SKDOT 7612003 <br /> CNT#: 161102174206 QTY: 150 WT/VOL P PROF# 156777 SKDOT 7612003 <br /> 100001 FEE, FUEL SURCHARGE 1.000 10.1800 0.00 10.18 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 4.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 388.9400 0.00 808.90 <br /> TOTAL CHARGE 808.90 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 808.90 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 808.90 <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 the applicable 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 /> any SK agreement signed by Customer and SK, and (2) incorporated <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, SK is authorized to charge Customer's account for <br /> this transaction. If Customer fails to make payment when due, an <br /> amount equal to the lesser of (i) 1.5% per month (18% per annum) or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br /> amounts outstanding. Customer certifies that the individual signing <br /> this Service Acknowledgement is duly authorized to sign and bind <br />