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1'/Sta _ IfClean � <br /> MANUAL <br /> WORK ORDER <br /> �_ NER�AcE ENVIRONMENTAL S�vICES, LLC <br /> HERITAGE-CRYSTAL CLEAN,LLC CCMS WO#: 2184 I STOREY RD <br /> (877)938-7948 <br /> COOLIDGE,AZ 65128 <br /> FRESNO S20-723-4167 AZD081705IQ <br /> CUSTOMER/SHIPPER: f �J T ECV4 �ejNj(C_ DESTINATION: <br /> 4370 Absolu#Avenue <br /> Contact Name: �� 4 IQQ Fresno, CA 93725 <br /> Phone Number; <br /> CARRIER: HERITAGE-CRYSTAL CLEAN, LLC EPA ID#: ILR 000 130 062 Phone Number:(877 938-7948 <br /> 16 GAL. 30 GAL. 55 GAL. <br /> DRUMS DRUMS DRUMS PROPER SHIPPING NAME <br /> TOTAL UNITS <br /> NON-�OT/�t i REGULATED,(AQUEOUS PARTS I"d�ERj <br /> This is to certify thaF fhe_abpve-named materials are properly classified,described,packaged,marked and labeled and are <br /> in Propercpndition for transport according to the applicable regulations of the Department of Transportation,as required. <br /> I aLspcertify that neimerhazardous waste,nor PCBs have been mixed wih the used oil ancVorparts cka ersolvent(T applicao'e). <br /> Per <br /> CustomerlShi r Per <br /> Dale HCCICarrier ° I! f JJJ IJJ :r� <br /> TODAY`S SERVICE <br /> WS# PROD. RTD. <br /> CODE DESCRIP710N UNIT SI NEXT LOCATION UNIT <br /> GALS. SVC. COMMENTS QTy TOTAL <br /> PRICE CHARGE <br /> :•r <br /> TAX <br /> MANIFEST# SERVICE SUBTOTAL <br /> PRODUCT DESCRIPTION: PRODUCTS <br /> UNIT <br /> LY CHARGE <br /> PRICE <br /> PRODUCT SALES TAX <br /> i7" <br /> ON SUBTOTAL PRODUCT&TAX <br /> G P CUSTOMER HEREBY VERIFIES THAT THE ABOVE SERVICES WERE PERFORMED AND THAT SAID CHARGE SUMMARY <br /> G P THEREFORE ARE HEREBY ACCEPTED.CUSTOMER ALSO HEREBY REAFFIRMS THE ACCURACY AND COMPLETENESS OF ALL <br /> G P INFORMATION CONTAINED INTHIS WORK ORDER ANO ALL DOCUMENTATION PREVIOUSLY SUBMITTED TO HCC.THIS WORK ORDER I$ TODAY'S SERVICE <br /> C P DEEMED PART OFTHE SERVICE AGREEMENTBETWEEN HERITAGE CRYSTAL CLEAN,LLC ANDTHE CERTIFICATIONS CONTAINED THEREIN PRODUCT&TAx <br /> G P CONCERNING THE MATERIALS TO BE HANDLED AND THE SERVICES TO BE PROVIDED ARE INCORPORATED Hrl BY REFERENCE TOTAL AMOUNT DUE <br /> G P AND DEEMED PART HEREOF AND SAID CERTIFICATfON5 ARE DEEMED REMADE FOR THE SERVICES COVERED BY THIS WORK ORDER. <br /> G P PER DATE TOTAL REMITTANCE <br /> CHECK NUMBER <br /> in USA FORM 20311 <br /> 1\ CUSTOMER THIS IS NOT AN INvnlr_j= <br />