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- a' ORDER <br /> f r r-, <br /> Crystal �� 169-10200 <br /> Cfean� <br /> MANUAL " FEDERAL EPA ID# <br /> ' ` <br /> WORK ORDER ' �' � �s ECOLOGY <br /> CLEAN,LLC CCMS WO#: <br /> (BM 9311.7948 HWY 95 <br /> BEATTY, NV 89OW <br /> h.ef�' :'_11 NVT330010000 <br /> CUSTOM ERISHIPPER: All feC l -fl LL' DESTINATION: <br /> . 5694 E. Clinton Ave. , <br /> Contact Name: Phone Number: Fresno, CA 93727 <br /> CARRIER: HERITAGE-CRYSTAL CLEAN, LLC EPA ID#: ILR 000 130 062 Phone Number:(877) 938-7948 <br /> 16 GAL. 30 GAL, 55 GAL. PROPER SHIPPING NAME TOTAL UNITS <br /> DRUMS DRUMS DRUMS <br /> gqueous Solvent Waste,UND82,Envircnr,iera!!y Pazardous Substanco,Liquid <br /> ,Aqueous ent Waste,W066,Corrosive Liquid,Basic,Inorganic h'.O.S. ` <br /> This is to certify that the above-named materials are properly classlfled,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 ceflily-that neilh amrdous waste,her PCBs have been mixed w4i the used dl andror pan deaner solvent(I applicable). 1'xo�.e Per Per <br /> Customer/Shi r Date 1HCCf6affier Dale <br /> SUMMARY OF <br /> TODAY'S SERVICE <br /> WS# PROD' DESCRIPTION RTD. UNIT SI NEXT LOCATION UNIT CdTY TOTAL <br /> CODE GALS. SVC. COMMENTS PRICE CHARGE <br /> --4400 aha L13f <br /> TAX <br /> SERVICE SUBTOTAL <br /> PRODUCTS <br /> PRODUCT DESCRIPTION; UNIT a <br /> PRICE TY CHARGE <br /> PRODUCT SALES TAX <br /> SUBTOTAL PRODUCT&TAX <br /> MACHINE INSPECTION SERVICEIPRODUCTS CHARGE SUMMARY <br /> Cleanlln6s5 G P CUSTOMER HEREBY VERIFIES THAT THE ABOVE SERVICES WERE PERFORMED ANDTHAT SAID SERVICES ANDTHE CHARGES TODAY'S SERVICE <br /> Lamp As5embly G P THEREFORE ARE HEREBY ACCEPTED. CUSTOMER ALSO HEREBY REAFFIRMSTHE 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,LLCAND THE CERTIFICATIONS CONTAINEDTHEREIN <br /> Lid Unobslrucled G P CONCERNING THE MATERIALSTO BE HANDLED AND THE SERVICESTO BE PROVIDED ARE INCORPORATED HEREIN BY REFERENCE TOTAL AMOUNT DUE <br /> Properly Grounded G P AND DEEMED PART HEREOF AND SAID CERTIFICATIONE ARE DEEMED REMADE FOR THE SERVICES COVERED BY THIS WORK ORDER. TOTAL REMITTANCE <br /> Local Phone I affixed G P PEI? DATE CHECK NUMBER <br /> Decals in Place G P <br /> 02003 Rev.01/08 Printed in USA FORM 20311 -CUSTOMER THIS IS NOT AN INVOICE <br />