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Safety-Kleen Systems, lnc. �/� <br /> A Clean Harbors Company E948694 <br /> 601 Riley Road,East Chicago,Indiana 46312-1638 <br /> 11"RIRBU a Te4hone(219)397-11331-1 //Fax(219)391-6185 DATE <br /> CUSTOMER'S NAME z 4 - <br /> ADDRESS <br /> COMMODITY I REMARKS <br /> CARRIER �7 Z <br /> ,3 <br /> LBS. GROSS <br /> M 4 M*y v, LBS. TARE-DRIVER ON OFF <br /> �j � •- LBS. NET @ PER LB. PRICE <br /> SHIPPER <br /> FAIRBANKS SCALE CAT.NO.083906 WEIGHER 02-10013(11113) <br />