Laserfiche WebLink
BRANCP i 25 FLORES,PATRICK 06/18104 17:58 PAGE 1 <br /> fety-Kleen <br /> 5400 Legacy Dr. <br /> Cluster II, Building 3 <br /> Plano, Texas 75024 <br /> 209-545-1011 <br /> REFERENCE MER <br /> CUSTOMER# 2801301 MARTIN BROWER 0026369075 <br /> SERVICE TAX: 0.07750 4704 FITE CT SRVC WEEK: 04-24 <br /> COMS TAX: 0.00000 SRVC DATE: 06/18104 17:55 <br /> PRODUCT TAX: 0.07750 STOCKTON CA 95205 <br /> PHONE 209 946-3748 <br /> PURCHASE ORDER# TAX EXEMPTION NBR: <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRAT QTY UNIT PRICE TAX CHARGE <br /> SERIAL# <br /> 00 100009 FUEL FEE SURCHARGE 1 8.1500 0.00 8.15 <br /> 00 92383 2383 PUMP ASSEMBLY 1 0.0000 0.00 0.00 <br /> 83309845 CLEAN 0 SPENT 0 <br /> SERVICE TERM 8 <br /> 00 94830 MODEL 94 W1237016317 1 157.2500 12.19 169.44 <br /> 94012857 CLEAN 2 SPENT 0 <br /> SER!I CE TERM 8 <br /> --------------------------- ------------- <br /> TOTAL SERVICEIPRODUCTS 165.4000 12.19 177.59 <br /> USEPA TRANSPORTER 1 TXR000060930 GENERATOR USEPA CAL000256206 <br /> USEPA TRANSPORTER 2 GENERATOR STATE <br /> MANIFEST DOC # 23511199 FORM CODE CA TRACKING # 104859603 <br /> US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID <br /> USED CLEANING COMPOUNDS, N.O.I.B.N. <br /> LRIUID (MOT USOOT OR USEPA REGULATED) <br /> AQUEOUS PARTS WASHER SOLUTION (8.3#GAL) <br /> TOTAL CONT 1 TYPE OM TTL QTY 8 UNIT WTIVOL G SKDOT 941 <br /> CONTAINER#40522076431 QTY 8 <br /> DESIGNATED FACILITY NAhEIADDRESS: <br /> SAFETY-KLEEN SYSTEMS, INC. <br /> 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> USEPA ID NO CAT000613968 TOTAL CHARGE 177.59 <br /> STATE 10 NO CAT000613968 WASTE MIN 0.00 <br /> ------------- <br /> TOTAL DUE 177,59 <br /> AMOUNT PAID CREDIT CARD 177.59 <br /> Mastercard ACCT# 7059 EXP DATE 09106 <br /> UNPAID BALANCE THIS RECEIPT 0.00 <br /> TOTAL RECEIVED 177.59 <br /> Machine clean and good condition? Yes <br /> Decals in place and legible? Yes <br /> Fusible link installed? Yes <br /> Emergency closing of lid unobstructed? Yes <br /> Machine properly grounded? Yes <br /> Spent solvent mets acceptance criteria? Yes <br /> Prop 65 warning (Calf. only)? Yes <br /> CEIERATOt STATUS 0 - 220 lbs/month <br /> Customer certifies that (i) the above-named materials are properly <br /> classified, packaged, marked and labeled, and are in proper condition <br /> for transportatiun according to the applicable regulations of the <br /> Department of Transportation and (ii) no material change has occurred <br /> either in the characteristics of the waste materials or in the process <br /> generating the waste materials. Customer agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) set forth in (a) <br /> the General Terms and Conditions provided separately to Customer or <br /> (b) any SK agreement signed by Customer and SK, and (2) incorporated <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, SK is authorized to charge Customer's account for this <br /> transaction. Customer certifies that the individual signing this Service <br /> Acknowledgement is duly authorized to sign and bind Customer. <br /> IN THE EVENT OF AN EMERGENCY CALL 1-800-468-1760 (24 hours) <br /> SIGNA NAME: GARY PARKER <br /> LAST PAGE <br />