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CSG SK-SSI,-UMO-01 Joseph R Lima Jr 03/07/16 11:21 PAGE 1 <br /> Safety-Ween 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 /> 2095451CII <br /> REFERENCE NBR. <br /> CUSTOMER# DI21596 Diesel Direct West Inc 76064379-1800675099 <br /> 3861 Duck Creek Dr SRVC WEEK: 2018.9 <br /> PO Box 31086 SRVC DATE: 03/07/18 <br /> Stockton CA 95215-7956 <br /> PHONE 916-857-1000 <br /> BILL TO CUSTCMER4 BILL TO ADDRESS: <br /> DT21596 Diesel Direct West Inc <br /> 3861 Dock Creek Dr <br /> PO Box 31086 <br /> Stockton CA 95215-7956 <br /> PHONE 916-857-1000 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 66636 USED OIL RECYCLE AUTOMOTI 275.000 0.3900 0.00 107.25 <br /> SERVICE TERM 6 WEEK <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 100D <br /> 10256 FEE, OIL SERVICE/STOP NON 1.000 145.0000 0.00 145.00 <br /> SERVICE TERM 8 WEEK <br /> ------------------------------------------ <br /> TOTAL SERVICE/PRODUCTS 145.3900 0.00 252.25 <br /> TOTAL CHARGE 252.25 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 252.25 <br /> UNPAID BALANCE THIS RECEIPT 252.25 <br /> .If high risk source, rep. certifies that load specific PCS & Silicon <br /> 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 (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 Porth 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) 1,5c 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 /> Customer. Customer acknowledges that it is responsible for maintaining <br /> its Generator Status and obtaining an EPA ID numbor if required by <br />