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BRANCH 7142 CSG 71 Benjamin Taylo 10/15/12 <br />40 <br />15:46 PAGE 1 <br />Safety-Kleen Systems, Inc. <br />2600 N Central Expy, Suite 400 <br />Richardson, TX 75080 <br />800-669-5740 <br />209-545-1011 <br />REFERENCE NBR. <br />CUSTOMER# 3399729 Firestone 028746 <br />59158390 <br />720 E Hammer Ln SRVC <br />WEEK: 2012-41 <br />Stockton CA 95210-2736 SRVC DATE: <br />10/15/12 15:45 <br />PHONE 209-951-2403 <br />BILL TO CUSTOMER# BILL TO ADDRESS: <br />0003402103 BFS RETAIL & COMMERCIAL OPERAT <br />6102 Sunrise Mall Dr <br />Citrus Heights CA 95610 <br />PHONE 916-726-7105 <br />PURCHASE ORDER# TAX <br />EXEMPTION NBR <br />PRODUCT/SERVICES <br />SERVICE/ <br />TOTAL <br />PRODUCT QTY UNIT PRICE <br />TAX CHARGE <br />66667 VACUUM SVC LIQ (NON-PQUAL 1232.000 <br />SERVICE TERM 24 WEEK <br />HALOGEN / CHLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br />VAC PH TEST: 5 <br /># CONTS: 1 TSDF: MANIFEST#: 58390 FORM CD: BL SK SHIP# <br />208490502 <br />CNT#: 121011884264 QTY: 1400 WT/VOL G PROFILE: 0150451 <br />SKDOT 3299 <br />66677 VACUUM SVC SLD (NON-PQUAL 168.000 <br />SERVICE TERM 24 WEEK <br />HALOGEN / CHLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br />VAC PH TEST: 5 <br />10919 STOP FEE <101 LIQ/31SOLIDS GAL 1.000 <br />10972 FEE, VAC SVC 20% SOLIDS 1400.000 <br />10955 FEE, VAC TANK 901-1500 1180.000 <br />----------------------------------------- <br />TOTAL SERVICE/PRODUCTS <br />TOTAL CHARGE <br />CREDITS <br />--------------- <br />TOTAL DUE <br />--------------- <br />UNPAID BALANCE THIS RECEIPT <br />Per SK BOG M420-001 the halogen detecting instrument has been <br />zeroed and validated. <br />GENERATOR STATUS <br />CESQG: Vehicle <br />Customer certifies that (i) the above-named materials are properly <br />classified, packaged, marked and labeled, and are in proper condition <br />for transportation 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/material or in the process <br />generating the waste/material. Customer agrees to pay the above <br />charges and to be bound by the terms and conditions (1) set forth in <br />(a) the General Terms and Conditions provided separately to Customer <br />or (b) any SK agreement signed by Customer and SK, and (2) <br />incorporated herein by reference. Unless otherwise indicated in the <br />payment received section, SK is authorized to charge Customer's <br />account for this transaction. Customer certifies that the individual <br />signing this Service Acknowledgement is duly authorized to sign and <br />bind Customer. The following provision is applicable to Safety-Kleen's <br />parts cleaner and paint gun cleaner services: Customer agrees that it <br />will not introduce any substance into the solvent or aqueous cleaning <br />solution, including without limitation any hazardous waste or <br />hazardous waste constituent, except to the extent such introduction is <br />incidental to the normal use of the machine. Customer further agrees <br />that it will not clean parts/paint guns that have been contaminated <br />with or otherwise introduce polychlorinated biphenyls (PCB's), <br />herbicides, pesticides, dioxins or listed hazardous waste into the <br />solvent or aqueous cleaning solution. Safety-Kleen has the capacity <br />and is permitted to accept, store, and/or reclaim the spent parts <br />washer solvent; paint thinners, solvents and paints generated by <br />customer; or dry cleaning filter cartridges, powder, and still <br />residues containing perchloroethylene, petroleum naphtha, or <br />triflurotrichloroethane dry cleaning solvents. Safety-Kleen and <br />customer agree that this agreement is intended to satisfy the <br />requirements of 40 CFR 262.20(e). IN THE EVENT OF AN EMERGENCY CALL 24 <br />HR EMERGENCY # 1-800-468-1760 (Safety-Kleen Contract # 94138) <br />CUSTOMER / GENERATOR: Willie Gladney <br />X f42 <br />TRANSPORTER: Benjamin Taylor <br />LAST PAGE <br />