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( WEISS WEIS&--rjIL CQMPANY, INC. Q <br /> ENVIRONMENTAL DIVISION <br /> OIL 1000 N. FRONT STREET TURLOCK, CA. 95380 <br /> co. (209) 668-7676 (800) 456-7390 <br /> INC. 215 <br /> ON-SITE ANTI-FREEZE RECYCLING <br /> Company 'n0 �J WUr ks Acct. # 1 eLJ <br /> Address r 1 u �1F <br /> City 1_6 Gl State 6A Zip cfS;40 <br /> Phone - �S� Contact Er i'L um i foil <br /> Gallons After Service Date of Service o? 9�— <br /> _P� -- Gallons Before Service Reference # <br /> /!O Total Gallons Serviced @ I `'9 per gal. 9 <br /> - T,c Anti-Freeze Added @ A/ C per gal �— <br /> 05 t (tG or <br /> Ph Freeze Point Non-Taxable <br /> Before _ 07 v ° Taxable <br /> After _ , Sales Tax <br /> Total $ <br /> R ed & Accepted by / Date <br /> CREDIT CARD AUTHORIZATION <br /> - <br /> METROOF PAYMENT PLEASE CHARGE MY CREDIT CARD <br /> CARD # <br /> 1ARGE / FARM PLAN <br /> I�' C.O.D. /CHECK # _/5 � EXPIRATION # <br /> ❑ VISA <br /> ❑ DISCOVER <br /> ❑ MASTERCARD SIGNATURE DATE <br /> LIMITED WARRANTY FOR GLYCLEAN RECYCLED ANTI-FREEZE <br /> -rne FPPF Chemical Company warrants anti-freeze recycled with the Glyclean Recycling System and <br /> extender product for two (2) years or 24,000 miles-whichever comes first from the date of recycling. <br /> Warranty information is available upon request. <br />