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CSG SK-SSL-UMO-01 Joseph R Lima Jr 01/18/16 07:07 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 69048833 <br /> 2577 W Yosemite Ave SRVC WEEK: 2016-3 <br /> Manteca CA 95337-9641 SRVC DATE: 01/18/16 07:05 <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 /> 66665 ANTIFREEZE (NON-PREQUAL) 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 4 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 66636 USED OIL NON-PREQUAL SERV 295.000 75.0000 0.00 75.00 <br /> SERVICE TERM 1 WEEK <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 75.0000 0.00 75.00 <br /> TOTAL CHARGE 75.00 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 75.00 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 75.00 <br /> If high risk source, SK rep. certifies that load specific PCB & <br /> Silicon testing have been completed prior to pumping this load. <br /> GENERATOR STATUS <br /> CESQG: Vehicle <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 and (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material. Customer agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) set forth in <br /> (a) the General Terms and Conditions provided separately to Customer <br /> or (b) any SK agreement signed by Customer and SK, and (2) <br /> incorporated herein by reference. Unless otherwise indicated in the <br /> payment received section, SK is authorized to charge Customer's <br /> account for this transaction. If Customer fails to make payment when <br /> due, an amount equal to the lesser of (i) 1.5% per month (18% per <br /> annum) or (ii) the maximum amount allowed by law, will be added to all <br /> unpaid amounts outstanding. Customer certifies that the individual <br /> signing this Service Acknowledgement is duly authorized to sign and <br /> bind Customer. The following provision is applicable to Safety-Kleen's <br /> parts cleaner and paint gun cleaner services: Customer agrees that it <br /> will not introduce any substance into the solvent or aqueous cleaning <br />