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CSG SK-SSL-BOX-23 Raymond Gomez 04/10/17 15:27 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75060 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleenl <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMER# LK00044 Lkq 72936578-1701607025 <br /> 2041 Navy Or SRVC WEEK: 2017-15 <br /> Attn Jerry SRVC DATE: 04/10/17 15:25 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> LK00044 Lkq <br /> 2041 Navy Or <br /> Attn Jerry <br /> Stockton CA 95206-1142 <br /> PF40NE 209-464-1111 <br /> PURCHASE ORDER.# TAX EXEMPT# <br /> PRODUCTISERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 90837 MODEL 90 w/2387 s 6365 1.000 365.7400 32.92 398.66 <br /> S/N 118982 TAG TOOOCDOOXX90209571 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 10.8300 0.97 11.80 <br /> ----------------------------------- <br /> TOTAL SERVICEIPRODUCTS 376.5700 33.99 410.46 <br /> TOTAL CHARGE 410.46 <br /> CREDITS 0.00 <br /> TOTAL DUE 410.46 <br /> UNPAID SALANCE THIS RECEIPT 410.45 <br /> Machine clean and good condition? Yes <br /> Lamp Assembly 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 /> Local Phone No. Sticker Affixed to Machine Yes <br /> Spent solvent meets acceptance criteria? Yes <br /> GENERATOR STATUS <br /> 0-220 lbs/month <br /> Customer certifies that {il 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 (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material, and (iii) the above referenced <br /> Generator Status is correct. Customer agrees to pay the above charges <br /> and to be bound by the terms and conditions (1) set forth in la) the <br /> General Terms and Conditions provided separately to Customer or (b) <br /> 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 <br /> this transaction. If Customer fails to make payment when due, an <br /> amount equal to the lesser of li) 1.58 per month (188 per annum) or <br /> iii) the maximum amount allowed by law, will be added to all unpaid <br />