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:SG SK-SSL-BPv ° ; Gomez , Raymond 06 ? 1 11 : 10 PAGE 1 - -- <br /> Safety-KIean Systems , Inc . - <br /> 42 Drive � 3 <br /> Norwewellll ,, MA NA 02061 �" � � � �: <br /> CORPORATE : 800169-5740 DUPLICATE TICKET <br /> 24 HR EMERGENCY : 800-468- 1760 ( Safety-Kleen) <br /> 2095451011 REFERENCE XSJC LOVELACE MRF / TRANSFER STAT <br /> :USTOMER# $1032988 San 21 Joaquin County North 86370316 - 2102869611 2323 E . LOVELACE RD , <br /> Count MANTECA , CA . ( 209 ) 982-5770 <br /> 17916 E Harney Ln SRUC WEEK : 2021-25 MON—FRI 7-4 SAT—SUN 7-4 <br /> Lodi CA 952401623 SRUC DATE : 06- 17-2021 <br /> PHONE 704-707-2520 <br /> Weighed : SABRINA <br /> ) ILL TO CUSTOMER# DILL TO ADDRESS : Deposit : SABRINA <br /> iA32677 San Joaquin County North Count BILI_ TO : 0 <br /> 17720 E Harney Ln <br /> Lodi CA 952401623 <br /> PHONE 209-887-3868 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> T/ 110ES Vehicle ID : W <br /> >ERVICESIPRODUCT QTV UNIT PRICE TAX TOTALCHARGE 816 <br /> F02 <br /> Reference : 9 <br /> 1383 DRUM155 GAL FOR 2 . 0 10 , 00 0 . 00 20 . 0 COMPANY : SAFETY KLEF. N <br /> 0 • F • <br /> 13383 DRUM , 55 WASTE O . F . 2 . 0 55 . 00 0 . 00 11010 PHONE : FC 110 GAL <br /> ICONTS : 2 TSDF : TPD MANIFESTO : 007876928SKS FORM CD : US SNIP# 234420123 <br /> :NT# 210604091472 QTY : 250 WT/ UOL P PROF# 156033 SKDOT# 7872676 01` igln : SALVAGE <br /> :NT# 210604091473 QTV : 250 WTIUOL P PROF# 156033 SKOOT# 7872676 <br /> 100001 FEE , FUEL SURCHARGE 1 . 0 13 . 48 0 . 00 13 , 48 DATE 1N : 06/21 /2021 TIME I N : 09 : 20 : 31 <br /> 1230 TAX HANDLING NIC 2 . 0 0400 0 . 00 0 . 00 DATE O:JT : 06/2112021 TIME OUT : 09 : 49 : 28 <br /> DRUM DROP 30 <br /> 100065 E-Manifest Fee 110 20 . 00 0 . 00 2040 OUTBOUND TICKET Number : 51 -01376214 <br /> TOTAL SERVICEIPRODUCTS 98448 0 . 00 163 , 48 SCALE 3 GROSS WT . 35060 LB <br /> SCALE 2 TARE WT . 30880 LBCOEDITS 0 ,10000 <br /> TOTAL CHARGE 1NET WEIGHT 4180 LB <br /> TOTAL DUE 163 . 48 <br /> RE ! RiNTED BY *_r <br /> - ------- ---------- - ------ ---- --- - SABRINr', 1 )9 : 50 : 12 <br /> UNPAID BALANCE THIS RECEIPT 163 . 48 <br /> Qty Description Amount <br /> 2 . 09 OIL SALVAGE 0 . 00 <br /> iENERATOR STATUS 2200+ lbs / month <br /> TICKET AMOUNT : 0 . 00 <br /> :ustomer certifies that ( i ) the I have established a program to reduce the volume <br /> ibove-named materials are properly or quantity and toxicity of the hazardous waste <br /> classified , packaged , marked and to the degree to be economically practicable . labeled , <br /> ind are in proper condition for transportation according to the applicable regulations of <br /> :he Department of Transportation ( ii ) no material change has occurred either in the <br /> :haracteristics of the wastelmaterial or in the process generating the waste/material , and <br /> i ) i ) the above referenced Generator Status i s correct • Customer agrees to pay the above X <br /> :barges and to be bound by the terms and conditions ( 1 ) set forth in ( a) the General Terms u — — <br /> ind Conditions provided separately to Customer or ( b) any SK agreement signed by Customer <br /> and SK , and ( 2) incorporated herein by reference . Unless otherwise indicated in the <br /> )ayment received section , SK is authorized to charge Customers account for this <br /> :ransaction . If Customer fails to make payment when due , an amount equal to the lesser of <br /> : i ) 1 : 5% per month ( 189 per annum) or ( ii ) the maximum amount allowed by law , will be <br /> idded to all unpaid amounts outstanding . Customer certifies that the individual signing <br /> :his Service Acknowledgement is duly authorized to sign and bind Customer . Customer <br /> icknowiedges that it is responsible for maintaining its Generator Status and obtaining an <br /> :PA 10 number if required by applicable law , The following provision is applicable to <br />