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BRANCH SSL CSG BOX-23 David L Buxton 10/29/15 13:16 PAGE 1 <br /> Safety-Kieen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: B00-468-/750 (Safety-Kleeril <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMER# LK00044 Lkq 68355994 <br /> 2041 Navy Dr SRVC WEEK: 2015-44 <br /> Attn Jerry SRVC [LATE: 10/29/15 13;15 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> BIL:. TO CUSTOMER4 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 EXEMPT# <br /> PRODUCTISERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT ¢TY UNIT PRIDE TAX CHARGE <br /> 90837 MODEL 90 1412387 6 6365 1.000 316.0500 28.44 344.49 <br /> SIN 119982 TAG TOOOOOOOXX90209571 CLEAN 3.00 SPENT 0,000 <br /> SERVICE TERN 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 10.5000 0.95 11.45 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 326.5500 29.39 355.94 <br /> TOTAL CHARGE 355.94 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 355.84 <br /> UNPAID BALANCE THIS RECEIPT 355.94 <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? Yea <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 and (ill 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 /> Ca} the General Terms and Conditions provided separately to Customer <br /> or (b) any SK agreement signed by Customer and SK, and f2} <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. If Customer Fails to make payment when <br /> due, an amount equal to the lesser of (i) 1.59 per month (188 per <br /> annum) or (ill the maximum amount allowed by law, will be added to all <br /> unpaid amounts outstanding. Customer certifies that the individual <br /> signing this Service Acknowledgement is duly authorized to sign and <br />