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R EEZETM J.B.IL <br />DOLT ANTIFREEZE RECYCLING 3 06 L ( <br />Z,,ycb To,4i <br />"^ 4521 Windermere Court <br />Salida, CA 95368 <br />qf <br />t Fax � 09) 545-5976 , ' o <br />F�un� � <br />Co.� ti%�C t'- —%7� G Date <br />Address <br />City /-7 ` %"-z�' �' _ State Zip <br />Phone Contact <br />RECYCLE SERVICE WITH THE ANTIFREEZE DOCTOR <br />Filter, purify, blend, adjust freeze point and PH levels <br />Add necessary antifreeze to make the blend a -344 50/50 mix <br />Fortify blend with antifreeze corrosion protection chemicals <br />ter/ Total Gallons in Drum After Service <br />Less Gallons in Drum Before Service f a <br />0 Equal Total Gallons Serviced x `/ $ <br />Add u ""Gallons Customers Antifreeze <br />Add Gallons Recyclers Antifreeze x `� $ <br />Add f- �� OZ. Formulated Antifreeze Fortifier <br />Combined with Special PH Balancing Chemicals a gl <br />And corrosion Protection Chemicals x <br />X_ $ <br />x $ <br />SALES TAX $ <br />INVOICE TOTAL $ <br />Cost PerO Bested 271 <br />Gallon = $ List Price = $ <br />All product is sold on a C.O.D. basis unless prior agreements have been made and spedfied. Manufacturers suggested retail <br />prices, specificatlons and availability are subject to change without notice. Our products are as specified by manufacturer. Any <br />alteration or deviation from above specifications involving extra costs will be executed only upon written orders and w ll become <br />an extra charge over and above the estimate. AD agreements contingent upon strikes, accidents or delays beyond our control. <br />Owner to carry fire, theft and other necessary insurance. <br />ACCEPTANCE. The atm prices, specifications and conditions are satisfactory and are hereby accepted. You areauthortmed <br />to ship as speed. 11 t>e m outlined above. <br />signature X ^ Date of Acceptance <br />