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CSG SK-SSL-BOX-23 Raymond Gomez 12/19/17 12:34 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 15080 <br /> CORPORATE: 800-669-5140 <br /> 24 HR EMERGENCY: 600-468-1760 [Safety--Kieen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMER# LK00044 Lkq 75431582-1706011829 <br /> 2041 Navy Dr SRVC WEEK: 2017-51 <br /> Attn Jerry SRVC NATE: 12/19/17 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> BILL TO CUSTinNER4 BILL TO ADDRESS: <br /> LK00044 Lkq <br /> 2041 Navy Dr <br /> Attn Jerry <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> PURCHASE ORDER# TAX EX£MPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 90937 MODEL 90 W/2387 & 6365 1.000 373.0600 33.58 406.64 <br /> SJR 118982 TAG TOOOOOOOXX90209571 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 12.1500 1.09 13.24 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 385.2100 34.67 419.89 <br /> TOTAL CHARGE 419.88 <br /> CREDITS 0.00 <br /> TOTAL DUE 419.88 <br /> UNPAID BALANCE THIS RECEIPT 419.88 <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 W 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 lifi) 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 (a) the <br /> General Terms and Conditions provided separately to Customer or (b) <br /> any SK aqreement 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. I£ Customer fails to make payment when due, an <br /> amount equal to the lesser of (i) 1.5% per month 8182 per annum) or <br /> (ii) the maximus amount allowed by law, will be added to all unpaid <br />