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Safety-Kleen Systems, Inc. E 9 4 4 7 9 6 <br /> A Clean Harbors Company <br /> 601 Riley Road,East Chicago,Indiana 46312-1638 <br /> safetgrNicco. Telephone(219)397-1131/Fax(22119)391-6185 DATE <br /> CUSTOMER'S NAME <br /> ADDRESS <br /> COMMODITY �f <br /> REMARKS <br /> CARRIER <br /> a• a, <br /> i� J Pti LBS. GROSS <br /> 'ALL O <br /> LBS. TARE-DRIVER ON OFF <br /> r+, N <br /> {y N LBS. NET @ PER LB. PRICE <br /> SHIPPER <br /> FAIRBANKS SCALE CAT. NO.083906 WEIGHER <br />