Laserfiche WebLink
CSG SK-SSL-1190-01 Joseph R Lima Jr 09/21/16 08:24 PAGE 1 <br /> Safety--Kleen Systems, Inc. <br /> 2600 H Central Expy. Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR LKERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CV-.jDiER# UTp59a8 Utility Trailer 7154207S <br /> 1260a S Harlan Rd SRVC WEER: 2016-I9 <br /> Lathrop CA 95330-8744 SRVC DATE: 09/21/16 08:24 <br /> PHONE 209-449-8800 <br /> BILL TO CUSTOMERS HILL TO ADDRESS: <br /> UTD5988 Utility Trailer <br /> 12608 S Harlan Rd <br /> Lathrop CA 95330-8744 <br /> PHONE 209-444-8800 <br /> PURCHASE ORDERS TAX EXf.MPT# <br /> PRODUCT/SERVICES <br /> SfJRII[EI TOTAL <br /> PRODUCT QTY UNIT PRICE TAA CHARGE <br /> 66636 USED OIL NOH-PREQUAL SERV 430.00D 0.2900 0.00 124.70 <br /> SERVICE TEM 12 WEEK <br /> v HALOGEN /CLOR-9-TECT TEST RESULT PASS: PPM < 1000 <br /> 65665 ANTIFREEZE (HOH-PREQUAi] 60.000 1.0000 0.00 60.00 <br /> SERVICE TERM 12 WEEK <br /> HAL04EN /CLOR-O-TELT TEST RESULT PASS: PPM < 1000 <br /> 10256 FEE, USED OIL STOP CHARGE 1.000 215.0000 0.00 215.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 216.2900 O.OD 399.70 <br /> TOTAL CHARGE 399.7D <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 99.70 <br /> UNPAID BALANCE THIS RECEIPT 399.70 <br /> If high risk source. rep. certifies that load specific PCB a Silicon <br /> testing have been completed prior to pumping this load. <br /> GENERATOR STATUS <br /> taxtctty Dir the nmsaruuus .--.._....__- <br /> practiCabla. <br /> SE{Jsahru <br /> CUSTOMER /GENERATOR: Utility Trailer adrean taylor <br /> SIGpt:wtire <br /> TRANSPORTER: Joseph R Lima Jr <br /> CS4 SK-SSL-UMa-01 Joseph R Lima Jr 09/23/16 08:24 PAGE 2 <br /> SHIPPING DOCUMENT <br /> REFERENCE NBR. <br /> CUSTOMER#/GENERATDR: UT05988 utility Trailer 71542075 <br /> 12608 S Harlan Rd <br /> Lathrop CA 95330-0744 SRVC DATE: 09/21/16 <br /> PHONE 209-444-8300 CONTACT NAME: Utility Trailer <br /> GENERATOR USEPA ID. CAL000289727 GENERATOR STATE 9060619999 <br /> MANIFEST#: 0OS5236445K5 FORM CD: 1D SHIP# 220360619 <br /> TRANSPORTER 1 TKR000081205 SAFpTY-%LEEN SYSTEMS. INC• <br /> 5050 SALIDA BLVD <br /> SAI.IDA.CA. 95368 <br /> lnrw PHONE: 209-545-1011 <br /> TRANSPORTER 2 <br /> US DOT DLSC'HIPTION (1NCLUDpg, PROVER SHIPPING NAME, HAYARD CLASS. peal IO) <br /> NON-RCRA HAZARDOUS WASTE. LI" <br /> (USED OIL) <br /> FEDERAL WASTE CODES NONE <br /> STATE WASTE CODES 221 <br />