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C:r <br /> ysta <br /> D <br /> STATE EPA I # <br /> MANUAL <br /> WORK ORDER US ECOLOGY <br /> HERITAGE-CRYSTAL CLEAN,LLC CCMSWO#: <br /> (877)938-7948 HWY 95 <br /> BEATTY, NV 89003 <br /> '71 NVT33001 0000 <br /> CUSTOMER/SHIPPER: 406." 0�r_-k DESTINATION: <br /> -33 5694 E. Clinton Ave. <br /> Contact Name: cl_� '? 5Z I Fresno, CA 93727 <br /> L Phone Number: <br /> 0,q 0,F6-19 -Z c) <br /> CARRIER: HERITAGE-CRYSTAL CLEAN, LLC EPA ID#: ILR 000 130 062 Phone Number:(877) 938-7948 <br /> BILL OF LADING <br /> 16 GAL. 30 GAL. 55 GAL. <br /> DRUMS DRUMS DRUMS PROPER SHIPPING NAME TOTAL UNITS <br /> Aqueous Solvent Waste,UN13082,Environmentally Hazardous Substance,Liquid <br /> N.G.S.kmeta l ConfaminatedSludge),5,Pg 111,451,UUUb,DUU/,UU06. <br /> Aqueous Solvent''.,`aste,UN3266,Corrosive Liquid,Basic,Inorganic N.O.S. <br /> F� r, � <br /> Ill,12 1,ww'D007,B098. J <br /> This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled and are <br /> in proper condition for transport according to the applicable regulations of the Department of Transportation,as required. <br /> I also certify that neither hazardous waste,nor PCBs have been mixed with the used oil and/or parts cleaner solvent If applicable). <br /> Per Per C5 <br /> Customer/Shipper Date HCC/Carrier Date <br /> SUMMARY OF CHARGES <br /> TODAY'S SERVICE <br /> PROD. DESCRIPTION RTD.] UNIT SI NEXT LOCATION UNIT OTY. TOTAL <br /> WS# <br /> CODE 411-S Svc. COMMENTS PRICE CHARGE <br /> __? Ju <br /> I -ZZ Ll 0 <br /> TAX <br /> SERVICE SUBTOTAL <br /> PRODUCTS <br /> PRODUCT DESCRIPTION: UNITE QTY. CHARGE <br /> PRIC <br /> PRODUCT SALES TAX <br /> SUBTOTAL PRODUCT&TAX <br /> MACHINE INSPECTION SERVICE/PRODUCTS CHARGE SUMMARY <br /> Cleanliness G P CUSTOMER HEREBY VERIFIES THAT THE ABOVE SERVICES WERE PERFORMED ANDTHAT SAID SERVICES ANDTHE CHARGES TODAY'S SERVICE <br /> Lamp Assembly G P THEREFORE ARE HEREBY ACCEPTED. CUSTOMER ALSO HEREBY REAFFIRMS THE ACCURACY AND COMPLETENESS OF ALL <br /> Drum Condition G P INFORMATION CONTAINED IN THIS WORK ORDER AND ALL DOCUMENTATION PREVIOUSLY SUBMITTEDTO HCC.THIS WORK ORDER IS PRODUCT&TAX <br /> Fusible Link Installed G P DEEMED PART OFTHE SERVICE AGREEMENT BETWEEN HERITAGE-CRYSTAL CLEAN,LLC AND THE CERTIFICATIONS CONTAINED THEREIN <br /> Lid Unobstructed G P CONCERNINGTHE MATERIALSTO BE HANDLED ANDTHE SERVICESTO BE PROVIDED ARE INCORPORATED HEREIN BY REFERENCE TOTAL AMOUNT DUE <br /> Properly Grounded nded G P AND DEEMED PART HEREOF AND SAID CERTIFICATIONS ARE DEEMED REMADE FORTHE SERVICES COVERED BYTHIS WORK ORDER. TOTAL REMITTANCE <br /> Local Plonalaffixed G P , <br /> Decals <br /> in Place <br /> G P PER DATE CHECK NUMBER <br /> ©2003 Rev.01/08 Printed in USA FORM 20311 <br /> CUSTOMER THIS IS NOT AN INVOICE <br />